Hemiarthroplasty for proximal humerus fractures.

Proximal humerus fractures are common injuries that are increasing in incidence with the aging of the population. While nonoperative treatment of some fracture patterns results in clinical success, other, more displaced and comminuted fractures may require surgery to ensure a successful outcome. It is important to evaluate both patient and fracture characteristics in deciding upon the appropriate type of treatment. Every effort should be made to perform a humeral sparing procedure in younger patients. In the elderly, especially with more complex four-part fractures and fracture dislocations, hemiarthroplasty and reverse total shoulder arthroplasty are indicated to decrease complication rates and improve functional outcomes. In hemiarthroplasties, it is critical to achieve proper implant height and positioning of the tuberosities. For those patients or fractures in which the tuberosities are unlikely to heal or cannot be adequately reconstructed, reverse total shoulder arthroplasty should be considered.