When a fracture of the proximal humerus occurs, ideal treatment involves preserving the head by  fixing it to the shaft---as well as fixing the lesser and greater tuberosity fragments. This is critical because the rotator cuff functions via its attachments to the tuberosities. In cases where extensive comminution  or poor bone quality exist, repair may not be possible. In such cases---because the socket is usually in good shape (there is no arthritis), replacement of "the ball" is performed. This is called a hemiarthroplasty. This a very challenging procedure  because functional outcome requires restoration of normal height, soft tissue balance, tuberosity attachment---and the tuberosities must heal. When the tuberosities fail to heal, or if they are excised, the hemiarthroplasty will never function ideally, and limited motion as well as pain may result. In these cases, revision to  Reverse shoulder replacement may be possible.

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