• Christopher Lenarz, Yousef Shishani, Christopher McCrum, Robert J Nowinski, T Bradley Edwards, and Reuben Gobezie.
• The Case Shoulder & Elbow Service, Department of Orthopaedic Surgery, University Hospitals of Cleveland, 11100 Euclid Avenue, HH5043, Cleveland, OH 44106, USA.
• Clin. Orthop. Relat. Res. 2011 Dec 1; 469 (12): 3324-31.

BackgroundThe treatment of comminuted proximal humerus fractures in older patients is challenging. Variable values of functional outcomes scores, ROMs, patient satisfaction, and bony healing have been reported with conventional techniques, including open reduction and internal fixation, percutaneous pinning, and hemiarthroplasty. Another alternative is reverse total shoulder arthroplasty, although it is unclear whether this provides better ROM or function.Questions/PurposesWe (1) evaluated ROM, pain level, and American Shoulder and Elbow Surgeons scores of patients who had a reverse total shoulder arthroplasty for displaced three- and four-part proximal humerus fracture and (2) identified clinical and radiographic complications from the procedure.Patients And MethodsWe retrospectively reviewed 30 patients in three institutions who had undergone a primary reverse total shoulder arthroplasty for displaced three- or four-part proximal humerus fractures. Mean age was 77 years (range, 65-94 years). Minimum followup was 12 months (mean, 23 months; range, 12-36 months).ResultsMean postoperative American Shoulder and Elbow Surgeons score was 78 (range, 36-98), mean active forward flexion was 139° (range, 90°-180°), and mean active external rotation was 27° (range, 0°-45°). Mean American Shoulder and Elbow Surgeons pain score was 0.7 (range, 0-5) and mean visual analog scale pain score was 1.1 (range, 0-5). Complications were identified in three of 30 patients (10%).ConclusionsAt short term, reverse total shoulder arthroplasty relieved pain and improved function. The complication rate compared favorably with those reported for other treatment alternatives.Level Of EvidenceLevel IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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