In the last decade the reverse shoulder replacement has offered a better solution for this problem. The advantage of the reverse shoulder replacement is that it depends only on the deltoid muscle for shoulder elevation. Theoretically the healing of the tuberosities is of less importance for range of motion. At the surprise of the shoulder surgeons studies show that even for a reverse shoulder replacement the healing of the tuberosities does provide better outcomes. Below is a case of a 75 year female who presented with a 4 part proximal humerus fracture after a fall. It is near impossible to anatomically reconstruct with plates and screws this type of a fracture. While the alternative would have been immobilization in a sling and conservative treatment we elected to proceed with reverse shoulder replacement because the patient was very active and independent and wanted to maintain her active lifestyle. Preoperative and postoperative xrays as shown below.
AP preoperative radiograph demonstrating the 4 part proximal humerus fracture
Immediate postoperative radiograph demonstrating the implanted reverse shoulder replacement
Further reading:
http://www.ncbi.nlm.nih.gov/pubmed/24246529
http://www.ncbi.nlm.nih.gov/pubmed/24659199
http://www.ncbi.nlm.nih.gov/pubmed/22652065 (Patients with acute proximal humeral fractures who undergo RSA appear to achieve superior 5-year functional outcomes compared with patients who undergo hemiarthroplasty.)
