Reverse shoulder arthroplasty for proximal humerus fractures

The optimal treatment of complex proximal humerus fractures continues to be debated. While many fractures can be treated nonoperatively, surgical intervention can be indicated to aid in restoring anatomy, allowing earlier range of motion and an improved final outcome. Historically, when surgical fixation of proximal humerus fractures was not possible due to fracture comminution, bone loss, head involvement or soft tissue/rotator cuff injury, hemiarthroplasty of the shoulder was utilized. Results of hemiarthroplasty, however, were unpredictable and largely dependent on the restoration of tuberosities. Reverse shoulder arthroplasty has emerged as a surgical treatment option in such cases, with results less-dependent on tuberosity healing. The design of reverse shoulder arthroplasty and evolution in surgical techniques have yielded results demonstrating it to be a safe option with consistent results in the treatment of these difficult injuries. Studies have shown rotational strength to be improved in cases where the tuberosities heal, and repair techniques as well as implant designs have evolved to optimize tuberosity healing. Complications of reverse shoulder arthroplasty for fracture are similar to those of other indications, including scapular notching, and neurologic injury. Further studies are still needed to assess the long-term validity of the results seen at the short and mid-term.