Reverse Shoulder Arthroplasty for the Treatment of 3 and 4- Part Fractures of the Humeral Head in the Elderly

Ioannis Gigis1, *, Alexandros Nenopoulos1, Dimitrios Giannekas1, Roderich Heikenfeld2, Theodoros Beslikas1, Ippokratis Hatzokos1
1 2nd Orthopedic Department, Aristotle University of Thessaloniki, “G. Gennimatas” General Hospital Thessaloniki, Thessaloniki, Greece
2 Center for Shoulder, Elbow and Hand Surgery, Center for Orthopaedics and Traumatology of the St. Elisabeth Group - Catholic Hospitals Rhein-Ruhr, St. Anna Hospital Herne, Marienhospital Herne University Hopsital, Marienhospital Witten, Germany

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© 2017 Gigiset al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the 2nd Orthopedic Department, Aristotle University of Thessaloniki, “G. Gennimatas” General Hospital Thessaloniki, Profiti Ilia 13, Pylaia, 55535, Thessaloniki, Greece, E-mails:,



Proximal humeral fractures in elderly patients present with severe comminution and osteoporotic bone quality.

Reverse shoulder arthroplasty has lately been proven beneficial in treating patients with complex proximal humeral fractures. The above technique is recommended and has better results in elderly than in younger individuals.


We performed a literature search in the databases Pubmed, Medline, EMBASE and Cochrane Library for published articles between 1970 and 2016 using the terms: proximal humerus fractures and reverse shoulder arthroplasty.


Significant benefits with the use of reverse prosthesis, especially in patients older than 70 years with a proximal humeral fracture, include reduced rehabilitation time as well as conservation of a fixed fulcrum for deltoid action in case of rotator cuff failure.

Compared with hemiarthroplasty and internal fixation, reverse prosthesis may be particularly useful and give superior outcomes in older patients, due to comminuted fractures in osteopenic bones.

However, significant disadvantages of this technique are potential complications and a demanding learning curve.Therefore, trained surgeons should follow specific indications when applying the particular treatment of proximal humeral fractures and be familiar with the surgical technique.


Although long-term results and randomized studies for reverse prosthesis are lacking, short and mid- term outcomes have given promising results encouraging more shoulder surgeons to use this type of prosthesis in proximal humeral fractures.

Keywords: Elderly, proximal humerus fractures, Reverse shoulder prosthesis, Fragility, Shoulder hemiarthroplasty, Internal fixation, Tuberosities fracture.