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Reverse shoulder arthroplasty can restore function after complex proximal humeral fractures, but the greater tuberosity remains an important determinant of shoulder mechanics. This updated systematic review and meta-analysis examined whether anatomic healing of the greater tuberosity improves outcomes after reverse arthroplasty performed for fracture. Across the included studies, patients with anatomic tuberosity healing generally demonstrated better shoulder motion and functional results than patients with malunion or nonunion. The finding is clinically relevant because reverse arthroplasty reduces dependence on the native rotator cuff, but tuberosity healing can still improve external rotation and overall shoulder performance. The message is therefore not simply that reverse arthroplasty works regardless of tuberosity status. Instead, meticulous tuberosity reduction and fixation remain worthwhile. Surgeons should consider fracture-specific stem positioning, tuberosity preparation, fixation constructs and postoperative rehabilitation protocols that support healing. The evidence is observational and therefore cannot prove causality, but the consistency of the association strengthens the argument for preserving the tuberosity whenever feasible. For fracture arthroplasty, surgical technique should therefore address both implant stability and restoration of the proximal humeral anatomy.
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Reverse shoulder arthroplasty can restore function after complex proximal humeral fractures, but the greater tuberosity remains an important determinant of shoulder mechanics. This updated systematic review and meta-analysis examined whether anatomic healing of the greater tuberosity improves outcomes after reverse arthroplasty performed for fracture. Across the included studies, patients with anatomic tuberosity healing generally demonstrated better shoulder motion and functional results than patients with malunion or nonunion. The finding is clinically relevant because reverse arthroplasty reduces dependence on the native rotator cuff, but tuberosity healing can still improve external rotation and overall shoulder performance. The message is therefore not simply that reverse arthroplasty works regardless of tuberosity status. Instead, meticulous tuberosity reduction and fixation remain worthwhile. Surgeons should consider fracture-specific stem positioning, tuberosity preparation, fixation constructs and postoperative rehabilitation protocols that support healing. The evidence is observational and therefore cannot prove causality, but the consistency of the association strengthens the argument for preserving the tuberosity whenever feasible. For fracture arthroplasty, surgical technique should therefore address both implant stability and restoration of the proximal humeral anatomy.
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