Functional outcomes of reverse shoulder arthroplasty compared with open reduction and internal fixation for acute proximal humeral fractures

Introduction Reverse shoulder arthroplasty (RSA) was traditionally used in treatment of massive rotator cuff arthropathy. In recent years, this surgical modality was adopted to be an alternative in the treatment of acute complex fracture of proximal humerus for geriatric patient and this management is gaining its popularity. This is a local study that aims at comparing the functional outcomes among the two surgical options in treatment of acute complex fracture of proximal humerus (3-parts, 4-parts, and fracture dislocation), i.e. open reduction and internal fixation (ORIF), and RSA. Methods A retrospective review was conducted on patients aged ≥60 years who underwent RSA or ORIF for acute proximal humeral fractures between 2015 and 2023 at a single local center. Data were extracted from the Clinical Management System. Outcomes included Oxford shoulder score (OSS), range of motion (ROM), revision rates, and intra-operative parameters. This study incorporates computed tomography-based stratification of Neer classification to optimize fracture characterization and ensure appropriate treatment allocation. Statistical analysis employed Chi-square test for categorical comparison, and ANOVA for group comparisons. Results 60 patients were included (29 ORIF, 31 RSA). RSA patients were older (mean age 77 vs. 67 years, p < 0.001) with higher Charlson Comorbidity Index (CCI) scores ( p = 0.040). For 4-part fractures , RSA showed superior OSS (41.2 vs. 30.2, p = 0.006) despite older age/poorer CCI. For 3-part fractures , no significant differences were observed in OSS or ROM. Revision rates were higher in ORIF (6.9% vs. 0%, p = 0.137). Conclusion RSA is preferable for 4-part fractures due to better functional outcomes, even in older patients with poorer comorbidities. ORIF remains appropriate for 3-part fractures and dislocations, offering comparable outcomes with less operative time and cost. Still, careful case selection, pre-operative planning, good surgical technique, and rehabilitation are the keystones for successful surgery.