Orthogate Subspecialty Journal Scan: Shoulder and Elbow

Curated critical appraisals of recent high-impact trials and practice-changing studies across shoulder and elbow, structured using the SBAR framework for immediate surgical and clinical application.

Featured Shoulder and Elbow Studies This Edition (September 2026)
Shoulder and Elbow

1. Cost-Effectiveness of Rotator Cuff Repair With Concomitant Subacromial Decompression at Mid-Term Follow-Up: A Systematic Review and Economic Analysis.

Authors: Saad Berreta R, Badin D, Fox H, Koyejo L, Mian M et al. | Journal: The Journal of the American Academy of Orthopaedic Surgeons (Aug 2026) | View Source / DOI

Situation

The objective of this study was to conduct a systematic review and cost-utility analysis comparing isolated rotator cuff repair (RCR) to RCR with concomitant subacromial decompression (SAD) for full-thickness tears.

Background

While SAD is frequently performed during RCR, the cost-effectiveness of adding this procedure to isolated RCR remains controversial and lacks rigorous economic evaluation.

Assessment & Findings
  • Study Design & Methodology: The study utilized a decision tree model over a 5-year time horizon using PRISMA guidelines.
  • Primary Findings: RCR with SAD was the dominant strategy, demonstrating a lower mean cost ($33,448 vs $34,593) and slightly higher QALYs (1.465 vs 1.454) compared to isolated RCR, yielding a positive incremental net monetary benefit (NMB) of $1,695.
  • Secondary Endpoints: Probabilistic sensitivity analysis favored RCR with SAD in 99.28% of 1,000 simulations, remaining cost-effective even with additional surgical time up to 43 minutes.
Recommendation & Practice Takeaway

Clinical Pearl: Despite higher initial intraoperative costs and time, adding a subacromial decompression during full-thickness rotator cuff repair is highly cost-effective at mid-term follow-up by significantly reducing downstream revision rates.

Shoulder and Elbow

2. Cost-Effectiveness of Surgery Versus Functional Bracing for Humeral Shaft Fractures in Adults: A Prespecified Economic Evaluation of the Finnish Shaft of the Humerus (FISH) Trial.

Authors: Suter C, Ibounig T, Reito A, Mattila H, Sumrein B et al. | Journal: The Journal of bone and joint surgery. American volume (Jul 2026) | View Source / DOI

Situation

This study evaluated the relative cost-effectiveness of surgical fixation compared to functional bracing for displaced, closed humeral shaft fractures in working-age adults.

Background

Although surgery and functional bracing offer comparable long-term clinical outcomes for humeral shaft fractures, the true economic impact encompassing indirect societal costs like prolonged work absence remains poorly defined.

Assessment & Findings
  • Design & Cohort: A prespecified economic evaluation was conducted alongside the multicenter randomized FISH trial involving 82 adults (mean age 48.9 years) followed for 2 years.
  • Primary Findings: From a societal perspective, surgery was more effective and less costly with a mean total cost of 23,680 Euros compared to 30,389 Euros for bracing, yielding an incremental net monetary benefit of 9,423 Euros (95% CI, 4,139 to 14,609).
  • Secondary Endpoints: Cumulative QALYs were comparable, but functional bracing incurred substantially higher indirect productivity losses and higher direct medical costs from secondary interventions.
Recommendation & Practice Takeaway

Clinical Pearl: For working-age adults sustaining displaced humeral shaft fractures, primary surgical fixation is highly cost-effective from a societal perspective primarily due to accelerated return to work and avoidance of secondary procedures.

Shoulder and Elbow

3. Long-term outcomes of reverse shoulder arthroplasty versus nonoperative treatment for 3- or 4-part proximal humerus fractures in elderly patients: results from a prior randomized clinical trial.

Authors: Lopiz Y, Alcobía-Díaz B, Coderch J, Rodrigo-Muro S, García-Fernandez C et al. | Journal: Journal of shoulder and elbow surgery (Sep 2026) | View Source / DOI

Situation

This study investigated the long-term functional and radiographic outcomes of reverse shoulder arthroplasty (RSA) versus nonoperative management in elderly patients sustaining displaced 3- or 4-part proximal humerus fractures.

Background

Proximal humerus fractures are highly prevalent in the elderly demographic, yet high-level randomized controlled trials evaluating the long-term durability of RSA compared to conservative care are lacking.

Assessment & Findings
  • Design & Cohort: This prospective randomized controlled trial followed 29 patients (mean age 88 to 92 years) for a mean of over 7 years.
  • Primary Findings: At final follow-up, RSA demonstrated significantly superior Constant scores (62 vs 51, P = 0.039) compared to nonoperative treatment.
  • Secondary Endpoints: Other functional outcomes trended favorably for RSA including DASH scores (16 vs 25, P = 0.069), with no significant difference in SF-12 or visual analog scale scores between cohorts.
Recommendation & Practice Takeaway

Clinical Pearl: In appropriately selected octogenarians with displaced 3- or 4-part proximal humerus fractures, primary reverse shoulder arthroplasty yields superior long-term shoulder function by preventing the progressive functional decline characteristically seen with nonoperative management.

Orthogate Weekly Journal Scan is curated and synthesized by ORION (Orthopaedic Research, Intelligence & Operations Navigator) for orthopaedic surgeons, fellows, and residents. Evidence synthesized under the clinical direction of Christian Veillette, MD, MSc, FRCSC.