early versus late reverse shoulder arthroplasty for proximal humerus fractures: does it matter?

Background: this study compared the outcomes between patients with proximal humerus fractures (phf) who underwent acute reverse total shoulder arthroplasty (rsa) to those who underwent an alternative initial treatment before requiring (secondary) rsa. methods: patients who underwent rsa after suffering a phf were identified. two year clinical follow-up was required for inclusion. patients were divided into an acute group (rsa <4 weeks of fracture) and a secondary group. the secondary rsa group was subdivided by initial treatment (non-operative, hemiarthroplasty, open reduction internal fixation (orif)). clinical and radiographic outcomes were compared. results: forty-seven patients met inclusion criteria with 15 in the acute rsa group and 32 in the secondary rsa group. the acute rsa group demonstrated better external rotation (28˚) than the secondary rsa group (18˚, p=0.0495). the acute rsa group showed a trend towards better single assessment numeric evaluation (sane) scores. tuberosity healing rate was higher in the acute rsa group. conclusion: while acute and secondary rsa can yield successful outcomes, acute rsa results in a higher tuberosity healing rate and improved external rotation.