The review of the current state of shoulder arthroplasty for proximal humerus fracture sequelae

Fractures of the proximal humerus are one of the most common injuries and their number continues to grow. We describe the most useful classification of theproximal humerus fractures sequelae, proposed by Boileau in 2001. Reverse shoulder prosthesis revolutionized the treatment of complex pathologies of the shoulder joint. 'There are studies in which the indications for the useof a reverse design are expanding, while the frequency of complications decreases. Atrophy and dysfunction of the deltoid muscle are considered a specificcontraindication to reverse shoulder arthroplasty. Among the risk factors of poor functional outcomes different authors distinguished: the number of previous interventions, male gender, depression, the numberof concomitant diseases, rotator cuff failure, deltoid muscle dysfunction, atrophy of the muscles of the shoulder girdle, lesions of the brachial plexus, and also abone defect size in the proximal humerus. The most common complications of reverse shoulder arthroplasty are: dislocations and instability, periprosthetic infection, aseptic loosening, scapular notchingand periprosthetic fractures. We can distinguish the following areas of further research in the field of shoulder joint replacement for proximal humerus fractures sequelae: 1) study of the long-term outcomes in large populations; 2) choosing the optimal surgical approach in different situations; 3) solving the problem of instability and determining the optimal tension of the shoulder muscles, the optimal position of the components; 4) study of the need and potential benefits of tuberosity fixation and rotator cuff tendons reattachment; 5) 3D planning and the use of patients specific instruments and implants. Keywords: Total Shoulder Replacement; Proximal Humeral Fractures; Malunited Fractures