Proximal Humerus Fractures: Reverse total shoulder arthroplasty versus Augmented Plate with Allograft. A comparative analysis

Background. Proximal humerus fractures (PHFs) represent approximately 5% of all fractures, occurring predominantly in elderly patients with osteoporosis. Functional limitations and high complication rates are common results after PHFs treatment . The aim of this study was to compare the functional outcomes and complications between reverse total shoulder arthroplasty (rTSA) and locking plate (LP) fixation augmented with intramedullary fibular allograft (IFA) in patients older than 65 years with four-part PHFs. Methods. A retrospective comparative analysis was performed including 72 patients: 37 treated with rTSA and 35 with LP fixation augmented with IFA. Mean follow-up was 30 months for the rTSA and 31 months for the ORIF with LP and IFA group. Functional outcomes were assessed using the Constant-Murley score (CMS) (absolute and relative) and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Complication and revision rates were recorded. Results. The rTSA group demonstrated higher CMS (absolute 74.3 vs 60.3; relative 92.3 vs 79.5), while DASH scores were comparable (14.5 vs 15.8). Although clinically relevant the difference was not of statistical significance. In the LP fixation, avascular necrosis of the humeral head occurred in 34.3% and greater tuberosity necrosis in 17.1%. The rTSA group demonstrated fewer complications, while reoperation rates were similar between groups (8.1% vs 8.6%). Conclusion. RTSA demonstrated a trend toward better functional outcomes and lower complications compared with LP with IFA. The latter remains a viable reconstructive option providing medial calcar support when joint preservation is preferred. More patients with randomisation are needed to further confirm these results.