Reverse shoulder arthroplasty for the treatment of proximal humeral fractures.

Proximal humeral fractures occurring in elderly patients often lead to significant functional disability. The outcome of nonoperative management is disappointing. Treatment with open reduction and internal fixation may result in osteonecrosis of the humeral head, and pain. Hemiarthroplasty is often associated with tuberosity nonunion and poor function. Reverse shoulder arthroplasty is an attractive alternative because of the ability of the prosthesis to compensate for tuberosity complications. Early studies have shown promise in using the prosthesis to treat these difficult patients. The next step will require prospective, randomized studies to determine which patient groups derive any benefit from reverse shoulder arthroscopy. The technology should be used judiciously.