Reverse Total Shoulder for Four-Part Proximal Humeral Fractures

The use of unconstrained humeral head replacement in acute fracture cases represents perhaps the most difficult indication for shoulder arthroplasty. The reason for this difficulty is that patients who are candidates for arthroplasty after proximal humeral fractures tend to be older with age-related osteopenia. This leads to an increase in complications, both systemic and shoulder specific. Reverse shoulder arthroplasty has been proposed as an alternative to replacement with a hemiarthroplasty in elderly patients with acute complex proximal humeral fractures. This review discusses the indications, contraindications, technique, and results of reverse total shoulder arthroplasty for 4-part proximal humeral fractures.