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roximal humerus fractures are the third most common extremity fracture in patients older than 60 years, and the incidence increases with age. The optimal treatment of these fractures in adults, especially those with osteoporotic bone, is debated. Depending on fracture type, treat[1]ment options are nonoperative treatment, percutaneous pin fixation, open reduction and internal fixation, HA, and RTSA. Factors that influence the choice of treatment are patient age, arm dominance, patient activity level, presence of other injuries, quality of bone, and configuration of the fracture (especially comminution, displace[1]ment, dislocation of the humeral head, head-splitting fracture, and medial column disruption).

For patients in whom nonoperative treatment or open reduction and internal fixation is not optimal, HA has been the mainstay, producing satisfactory results. Neer published one of the first studies of HA to treat proximal humerus fractures, reporting that 39 of 43 outcomes were good to excellent. Subsequent studies were unable to duplicate those results. Poor results because of tubero[1]sity malunion, nonunion or resorption of the tuberosities, or rotator cuff tearing have been reported. All of these mechanisms of failure produce a rotator cuff[1]deficient shoulder with subsequent shoulder weakness, loss of motion, and, in some cases, pain.

Reverse total shoulder arthroplasty was designed for patients with cuff tear arthropathy or large rotator cuff tears and arthritis. The prosthetic design of the RTSA allows the deltoid muscle to elevate the arm without an intact rotator cuff. Because of the high incidence of rotator cuff dysfunction after HA for the treatment of proximal humerus fractures, RTSA has been used in patients with rotator cuff deficiency or those in whom tuberosity osteo[1]synthesis is unachievable. Studies of RTSA for the treatment of patients with proximal humerus fractures have shown acceptable results clinically and radiographically.

There is increasing controversy regarding whether HA or RTSA provides the best results for surgical treatment of proximal humerus fractures. The goal of this systematic review was to compare the clinical results of HA vs RTSA for the treatment of proximal humerus fractures.