Improving Accuracy in Reverse Total Shoulder Arthroplasty for Acute Proximal Humerus Fractures Using Virtual Surgical...

Background/Objectives: Reverse total shoulder arthroplasty (rTSA) is the preferred treatment for elderly patients with complex proximal humerus fractures. Accurate humeral stem positioning remains challenging in these cases due to complex fracture patterns, which may lead to postoperative complications. Virtual surgical planning (VSP) may assist in optimizing humeral stem and greater tuberosity positioning; however, its clinical impact in fracture-related rTSA has not yet been evaluated. This study aimed to assess whether VSP improves postoperative range of motion (ROM). Methods: A comparative cohort study was conducted, comprising a prospective VSP group and a retrospective control group. Patients underwent rTSA for proximal humerus fractures. Primary outcomes were ROM during forward elevation, abduction, and external rotation at two months and one year postoperatively. Secondary outcomes included complications, procedure time, greater tuberosity repositioning and healing, and postoperative deviation in humeral stem height compared with the preoperative plan. Statistical analyses included independent t-tests, Mann-Whitney U tests, and chi-square tests. Results: A total of 48 patients were included: 27 in the VSP group and 21 in the non-VSP group. At two months, abduction was significantly greater in the VSP group (76° vs. 63°, p = 0.05). Forward elevation and external rotation were numerically higher in the VSP group but did not reach statistical significance (p < 0.1). Stem height deviation was significantly lower in the VSP group (3 mm vs. 12 mm, p < 0.001). Conclusions: VSP enables more accurate humeral stem positioning in rTSA for proximal humerus fractures. Although no statistically significant improvements in ROM were observed at one year, VSP demonstrated superior accuracy in stem positioning.