Reverse Shoulder Arthroplasty for Acute Proximal Humeral Fractures in the Geriatric Patient

Proximal humeral fractures are frequently encountered in the elderly population. While the majority of these fractures can be managed nonoperatively, 2-, 3-, and 4-part fractures, head splitting, and complex fracture dislocations typically require operative management. Open reduction and internal fixation (ORIF) is a popular treatment option for displaced fractures. Advent of locking plates potentially imparts a better option for patients with osteoporotic bone. Hemiarthroplasty has traditionally been used in proximal humeral fractures not amendable to ORIF. While typically providing good pain control, results of hemiarthroplasty have demonstrated inconsistent shoulder motion. Tuberosity malposition or poor healing is a major culprit in unsatisfactory postoperative range of motion. Reverse shoulder arthroplasty has been used in the setting of rotator cuff arthropathy with successful results. Reverse shoulder arthroplasty has recently been used in the setting of acute proximal humeral fractures of the elderly individuals. This technology has shown promising results with mean active anterior elevation from 97° to 122° reported with complication rates of 15% to 28% in short-term studies. Long-term studies and higher level evidence studies with comparison to hemiarthroplasty and ORIF are needed.