Tuberosity Management in Reverse Shoulder Arthroplasty for Proximal Humerus Fractures

The predictability of outcomes with reverse shoulder arthroplasty (RSA), compared with hemiarthroplasty or open reduction and internal fixation, has led to its increased use in treating displaced three- and four-part proximal humerus fractures (PHFs) in patients older than 65 years. Although RSA was initially designed to restore humeral elevation in the absence of a functional rotator cuff, studies have shown improved patient-reported outcomes and range of motion in patients who achieve tuberosity union following surgery. Despite numerous advancements in implant design over the past decade, optimal strategies to maximize outcomes in PHFs remain debated. This article reviews indications, intraoperative decision making, implant selection, and surgical techniques to optimize outcomes for patients undergoing RSA for PHFs.