A 70-year-old woman sustains a displaced three-part proximal humeral fracture (greater tuberosity + surgical neck). She is cognitively intact, lives alone, and is fully independent. The treatment option that offers superior functional outcomes with lower rates of reoperation compared to hemiarthroplasty in elderly patients with complex proximal humeral fractures is:

• A Non-operative management with sling immobilisation
• B Open reduction and internal fixation with locking plate
• C Reverse total shoulder arthroplasty (RTSA) ✓
• D Hemiarthroplasty with tuberosity reconstruction

Explanation

Reverse total shoulder arthroplasty (RTSA) has become the preferred implant for complex proximal humeral fractures in elderly patients (>65 years, comminuted 3- and 4-part fractures) because it does not rely on tuberosity healing for function — the deltoid muscle drives forward elevation directly. Hemiarthroplasty (D) requires successful tuberosity healing and remodelling, which fails in up to 50% of cases, leading to poor functional results. Multiple randomised controlled trials (PROFHER, Danish studies) and meta-analyses support RTSA over hemiarthroplasty for fractures in elderly patients where ORIF is not feasible.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.