Systematic review of 92 studies (4,536 patients) comparing the four major surgical options for displaced 3- and 4-part proximal humerus fractures: ORIF, closed reduction and percutaneous pinning (CRPP), hemiarthroplasty (HA), and reverse shoulder arthroplasty (RSA), with a minimum 1-year follow-up required for inclusion.
When choosing between surgical options for a complex proximal humerus fracture, expect ORIF to yield the best functional scores but budget for a nearly 1-in-8 reoperation risk — if the patient is elderly with poor bone stock, HA and RSA deliver equivalent outcomes to each other with far fewer reoperations, though with HA you must counsel specifically about tuberosity nonunion in roughly 1 in 6 cases.
Systematic review of 92 studies (4,536 patients) comparing the four major surgical options for displaced 3- and 4-part proximal humerus fractures: ORIF, closed reduction and percutaneous pinning (CRPP), hemiarthroplasty (HA), and reverse shoulder arthroplasty (RSA), with a minimum 1-year follow-up required for inclusion.
When choosing between surgical options for a complex proximal humerus fracture, expect ORIF to yield the best functional scores but budget for a nearly 1-in-8 reoperation risk — if the patient is elderly with poor bone stock, HA and RSA deliver equivalent outcomes to each other with far fewer reoperations, though with HA you must counsel specifically about tuberosity nonunion in roughly 1 in 6 cases.