Reverse shoulder arthroplasty for the treatment of three and four part fractures of the proximal humerus in patients older than 75 years old.

Reverse shoulder arthroplasty is an attractive alternative option in treating three- or four-part fractures of the proximal humerus. The main goal of the current study was to evaluate the functional and radiographic results after primary reverse shoulder arthroplasty of three- or four-part fractures of the proximal humerus in patients older than 75 years old. Between 2008 and 2010, 29 consecutive patients with a three- or four-part fracture of the proximal humerus undergoing a reversed shoulder prosthesis were included. There were 16 women and 13 men, with a mean age of 81 years (range 78 to 85). The dominant arm was involved in 18 patients (62%). All of the operations were carried out within 10 days of the injury. The patients were followed up for a mean of 26 months (range 10 to 36). The mean postoperative Constant-Murley score at the end of the follow-up period for each patient (age- and gender-matched) was 73.3% (range 58 to 92%). The mean Constant score was 75% in the group of patients with fixation of the tuberosities and 72.3% in the patients with no fixation of the tuberosities (p = 0.06). There was no significant difference in Constant score between patients who were operated by the fifth day after the fracture and patients who had an operation between the sixth and tenth day after the injury (Constant score of 74% and 71%, respectively, p = 0.07). Complications occurred in 12 patients. One patient sustained a fracture of the acromion intraoperatively. Four patients (13.8%) developed heterotopic ossification. One had a nontraumatic anterior dislocation due to wrong retroversion of the glenoid component. Scapular notching was observed in six shoulders (20.6%).