Hemi, Conventional, and Reverse Total Shoulder Arthroplasty for the Treatment of Proximal Humerus Fractures

Abstract

Proximal humerus fractures account for 4–5% of all adult fractures. Knowledge of the anatomy is vital in determining treatment and achieving optimal surgical outcome. A thorough history and physical exam is the foundation for correct treatment. Indications for shoulder arthroplasty for proximal humerus fractures in appropriate surgical candidates include three- and four-part fracture-dislocations, head-splitting fractures, impaction fractures of the humeral head with involvement of more than 50% of the articular surface, displaced anatomic neck fractures, and select three- and four-part proximal humerus in which there is a high risk of osteonecrosis or failure of internal fixation. Hemiarthroplasty is performed except in patients who are greater than 70 years old with poor tuberosity bone quality due to osteoporosis or comminution, preexisting chronic rotator cuff tear, or preexisting osteoarthritis of the glenohumeral joint. In such cases, reverse shoulder arthroplasty is preferred. Anatomic or conventional total shoulder arthroplasty is not utilized in acute proximal humerus fractures. Success with shoulder hemiarthroplasty or reverse shoulder arthroplasty for proximal humerus fractures is largely dependent on surgical technique. Goals of either surgery are proper restoration of prosthetic height, proper version, secure tuberosity attachment, and accurate soft tissue balancing of the rotator cuff.