When fracture of the proximal humerus occurs, our overwhelming preferance is to repair the fracture in order to preserve the native anatomy---which means an acceptable bearing surface between ball and socket, and integrity of the rotator cuff. So, the tuberosity fragments require excellent fixation. There are many factors that impact on decision-making regarding how to fix such fractures. These include patient age, functional expectations, bone quality, comminution, to name a few. There are cases for which the damage is too severe to "fix" in which case the "ball" can be replaced. However, this procedure----Hemiarthroplasty for fracture ---is frought with potential complications. The most notable is the failure of the tuberosities to heal. For this reason, patients older than 65-70 are better served by a reverse design--which obviates the criticality of tuberosity healing in terms of function. ofcourse, if the tuberosities unite external rotation will be better, but at a minimum, a reverse will enable reasonable overhead function regardless.
In younger patients ie up to age 60 or so, most surgeons will still suggest a hemiarthroplasty-----which has fewer complications down the road---so long as it can be accomplished effectively. Newer implant designs have "platform" options which allow easier revision down the road, if necessary, to revise to a reverse design, without having to remove the stem. The video below shows reasonable function although the postoperative xrays raise questin as to the extent of tubersoty healing.
In younger patients ie up to age 60 or so, most surgeons will still suggest a hemiarthroplasty-----which has fewer complications down the road---so long as it can be accomplished effectively. Newer implant designs have "platform" options which allow easier revision down the road, if necessary, to revise to a reverse design, without having to remove the stem. The video below shows reasonable function although the postoperative xrays raise questin as to the extent of tubersoty healing.
