Proximal humerus fractures are the third most common fracture in elderly patients. Hemiarthroplasty has been the treatment of choice in patients with bone quality and fracture patterns not amenable to open reduction and internal fixation. Reverse total shoulder arthroplasty is a newer option that appears to be less dependent on tuberosity healing than hemiarthroplasty. The authors hypothesized that reverse total shoulder arthroplasty provides improved functional outcomes compared with hemiarthroplasty for fractures in elderly patients.A retrospective review was performed of all patients treated with arthroplasty for acute proximal humerus fractures in an orthopedic practice using a Current Procedural Terminology code search, patient charts, and radiographs. Validated outcome scores were used to assess satisfaction, function, and general well-being. Twenty-three patients were treated for acute proximal humerus fractures (11 reverse total shoulder arthroplasties and 12 hemiarthroplasties). Three patients were lost to follow-up, and 6 patients were deceased. Mean follow-up was 3.6 years (range, 1.3-8 years). Reverse total shoulder arthroplasty outperformed hemiarthroplasty with regard to forward flexion, American Shoulder and Elbow Society score, University of Pennsylvania shoulder score, and Single Assessment Numerical Evaluation score.Reverse total shoulder arthroplasty is a reliable option for acute, proximal humerus fractures that are not amenable to closed treatment or reconstruction in elderly patients. Improved functional outcomes when compared with hemiarthroplasty must be balanced against the increased cost and limited life expectancy of patients with this injury.

Seventy-one patients (93 implants) had a de la Caffinière prosthesis implanted between 1980 and 1989 and were reviewed and reported in 1997. We reviewed this series 10 years later. Similar outcome measures were used as in the original study, pinch and grip strength measured and validated outcome scores obtained (DASH and EQ-5D). Radiographic outcome was assessed. Twenty-six patients with 39 implants were available for review at a mean of 19 years (range, 16-26 years). Survivorship at 26 years was 73.9% (95% CI, 61.2 to 86.6) for re-operation and 26.0% (95% CI, 0 to 52.7) for all failure. Patients had satisfactory power and thumb mobility and continued to be satisfied without pain. Registries should log such prostheses and add to implant survival data.

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