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Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Background The treatment of comminuted proximal humerus fractures in older patients is challenging. Variable values of functional outcomes scores, ROMs, patient satisfaction, and bony healing have been reported with conventional techniques, including open reduction and internal fixation, percutaneous pinning, and hemiarthroplasty. Another alternative is reverse total shoulder arthroplasty, although it is unclear whether this provides better ROM or function. Questions/purposes We (1) evaluated ROM, pain level, and American Shoulder and Elbow Surgeons scores of patients who had a reverse total shoulder arthroplasty for displaced three-and four-part proximal humerus fracture and (2) identified clinical and radiographic complications from the procedure. Patients and MethodsWe retrospectively reviewed 30 patients in three institutions who had undergone a primary reverse total shoulder arthroplasty for displaced three-or four-part proximal humerus fractures. Mean age was 77 years (range, 65-94 years). Minimum followup was 12 months (mean, 23 months; range, 12-36 months). Results Mean postoperative American Shoulder and Elbow Surgeons score was 78 (range, 36-98), mean active forward flexion was 139°(range, 90°-180°), and mean active external rotation was 27°(range, 0°-45°). Mean American Shoulder and Elbow Surgeons pain score was 0.7 (range, 0-5) and mean visual analog scale pain score was 1

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RSA as a reconstructive procedure improved function at the time of short-term follow-up in our young patients with glenohumeral arthritis and rotator cuff deficiency. Objective outcomes in our patient cohort were similar to those in previously reported studies. However, overall satisfaction was much lower in this patient population (81%) compared with that in the older patient population as reported in the literature (90% to 96%).