title: Reverse Shoulder Arthroplasty for the Treatment of 3 and 4- Part Fractures of the Humeral Head in the Elderly.
abstract: BACKGROUND
  Proximal humeral fractures in elderly patients present with severe comminution and osteoporotic bone quality. Reverse shoulder arthroplasty has lately been proven beneficial in treating patients with complex proximal humeral fractures. The above technique is recommended and has better results in elderly than in younger individuals.
  
  
  METHODS
  We performed a literature search in the databases Pubmed, Medline, EMBASE and Cochrane Library for published articles between 1970 and 2016 using the terms: proximal humerus fractures and reverse shoulder arthroplasty.
  
  
  RESULTS
  Significant benefits with the use of reverse prosthesis, especially in patients older than 70 years with a proximal humeral fracture, include reduced rehabilitation time as well as conservation of a fixed fulcrum for deltoid action in case of rotator cuff failure. Compared with hemiarthroplasty and internal fixation, reverse prosthesis may be particularly useful and give superior outcomes in older patients, due to comminuted fractures in osteopenic bones. However, significant disadvantages of this technique are potential complications and a demanding learning curve.Therefore, trained surgeons should follow specific indications when applying the particular treatment of proximal humeral fractures and be familiar with the surgical technique.
  
  
  CONCLUSIONS
  Although long-term results and randomized studies for reverse prosthesis are lacking, short and mid- term outcomes have given promising results encouraging more shoulder surgeons to use this type of prosthesis in proximal humeral fractures.
authors.affiliation: 2 Orthopedic Department, Aristotle University of Thessaloniki, "G. Gennimatas" General Hospital Thessaloniki, Thessaloniki, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Gigis
authors.affiliation: 2 Orthopedic Department, Aristotle University of Thessaloniki, "G. Gennimatas" General Hospital Thessaloniki, Thessaloniki, Greece.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Nenopoulos
authors.affiliation: 2 Orthopedic Department, Aristotle University of Thessaloniki, "G. Gennimatas" General Hospital Thessaloniki, Thessaloniki, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Giannekas
authors.affiliation: Center for Shoulder, Elbow and Hand Surgery, Center for Orthopaedics and Traumatology of the St. Elisabeth Group - Catholic Hospitals Rhein-Ruhr, St. Anna Hospital Herne, Marienhospital Herne University Hopsital, Marienhospital Witten, Germany.
authors.forename: Roderich
authors.initials: R
authors.lastname: Heikenfeld
authors.affiliation: 2 Orthopedic Department, Aristotle University of Thessaloniki, "G. Gennimatas" General Hospital Thessaloniki, Thessaloniki, Greece.
authors.forename: Theodoros
authors.initials: T
authors.lastname: Beslikas
authors.affiliation: 2 Orthopedic Department, Aristotle University of Thessaloniki, "G. Gennimatas" General Hospital Thessaloniki, Thessaloniki, Greece.
authors.forename: Ippokratis
authors.initials: I
authors.lastname: Hatzokos
keywords: Elderly; Fragility; Internal fixation; Reverse shoulder prosthesis; Shoulder hemiarthroplasty; Tuberosities fracture; proximal humerus fractures