Comparison of Locking Plate Osteosynthesis, Hemiarthroplasty, and Reverse Total Shoulder Arthroplasty in the Treatment of Neer Type 3 and 4 Proximal Humerus Fractures in the Elderly A Retrospective Study

Background: Proximal humerus fractures (PHFs) are common in elderly individuals, and various surgical options exist for the treatment of Neer type 3 and type 4 fractures. This study aimed to compare the clinical and functional outcomes of locking plate osteosynthesis (LPO), hemiarthroplasty (HA), and reverse total shoulder arthroplasty (RTSA). Methods: A retrospective evaluation was conducted on 44 patients with Neer type 3 or 4 PHFs who underwent LPO, HA, or RTSA. The Constant‒Murley score (CMS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and American Shoulder and Elbow Surgeons (ASES) score were evaluated. Range of motion was measured in terms of forward flexion, extension, abduction, and internal/external rotation. Results: The mean age was 76.6 ± 4.2 years, and the majority of the patients were female (70%). Compared with the LPO and RTSA groups, the HA group demonstrated significantly worse functional outcomes (CMS: 50.6 ± 2.3; ASES: 60.1 ± 2.3; DASH: 37.5 ± 2.3) and range of motion (p