Arthroplasty for fractures of the proximal part of the humerus

Proximal humeral fractures account for 4% to 5% of all fractures. Most of these fractures are nondisplaced or minimally displaced and amenable to nonsurgical treatment or open reduction and internal fixation. Complex proximal humeral fractures with displaced three- and four-part fragments, fracture-dislocations, and humeral head splits are more difficult to treat. In older patients, hemiarthroplasty or reverse shoulder arthroplasty is often the indicated treatment. Arthroplasty in this patient cohort is very technique-dependent and relies on preserving deltoid function, proper component placement and fixation, and tuberosity healing. Complications include tuberosity nonunion, instability, heterotopic ossification, and infection. Although pain relief is predictable, it is often difficult to achieve functional improvement. Results depend on the patient's age, timing of the surgery, tuberosity healing, and adequate rehabilitation. Recently, successful outcomes for reverse total shoulder arthroplasty have been reported in older, low-demand patients with cuff deficiency, deficient bone in the tuberosity, or compromised healing of the tuberosity.