Reverse Prosthesis for Proximal Humerus Fracture, Technique and Results

The reverse prosthesis has become a treatment of choice for glenohumeral osteoarthritis in a cuff-deficient shoulder. It allows restoration of mobility despite the loss of rotator cuff function. Hemiarthroplasty, the historical standard of care for proximal humeral fractures requiring replacement, fails most commonly because of tuberosity nonunion. Therefore, in the face of poor bone quality, the reverse prosthesis is a logical choice for acute fractures to improve postoperative mobility in elevation regardless of tuberosity healing. Nevertheless, the healing of the tuberosities may influence the recovery in active external rotation. The purpose of this article is to report on the superolateral technique to implant a reverse shoulder prosthesis for acute proximal humeral fractures, emphasizing the technique of tuberosity fixation, and to analyze previously published series. Considering the follow-up and complication risks, the reverse prosthesis should be reserved for fractures involving elderly patients. The decision to use a reverse prosthesis for an acute fracture should be based on a thoughtful risk-benefit analysis between hemiarthroplasty and reverse shoulder arthroplasty.