Indications, technique, and pitfalls of reverse total shoulder arthroplasty for proximal humerus fractures

Management of proximal humerus fractures with hemiarthroplasty has been shown to yield unpredictable and inconsistent outcomes. Risk factors for clinical failure following hemiarthroplasty include postoperative tuberosity failure, advanced age, female sex, osteoporosis, and inability or unwillingness to participate in the extensive rehabilitation required. In this difficult-to-manage injury, reverse total shoulder arthroplasty (rTSA) for fracture has been shown to reliably restore elevation, even in cases of tuberosity failure, and to restore rotational movements if the tuberosity heals. In addition, a fracture-specific implant design has been suggested to improve the likelihood of tuberosity healing. Early results indicate that fractures of the proximal humerus that are indicated for arthroplasty should be considered for rTSA. Tuberosity integrity appears to impact rotational movement but not restoration of elevation.