BackgroundProximal humerus fracture is one of the most common fractures in the elderly population. However, in patients with complex fracture patterns, there is still no general consensus in the best treatment method. This study aims to evaluate the outcomes between those treated with reverse total shoulder arthroplasty (rTSA) and open reduction internal fixation (ORIF).MethodsAll geriatric patients (> 60 years of age) with proximal humerus fractures undergoing surgical treatment were analysed. There were 25 patients treated with rTSA and 75 with ORIF. Propensity score matching was used to select 25 matching patients from the ORIF group according to age and gender. All patients underwent surgical intervention within 7 days (mean 3.8 days). All patients followed a protocol-driven rehabilitation programme with outcome assessment at 3, 6, 12 and 24 months. Constant score, qDASH, range of motion, rate of complications and revision surgery were recorded and compared.ResultsTwenty-five rTSA were age and gender matched with 25 ORIF patients. The average age of patients in rTSA and ORIF groups were 77.0 years and 75.2 years respectively. At 3 months, mean Constant score was 37.7 (rTSA) vs 45.5 (ORIF) (p= 0.099). Mean qDASH score was 50.6 (rTSA) vs 29.4 (ORIF) (p= 0.003). Mean forward flexion range was 72.9° (rTSA) vs 94.4° (ORIF) (p= 0.007). Mean abduction range was 64.0° (rTSA) vs 88.6° (ORIF) (p= 0.001). At 2 years, mean Constant score was 72.8 (rTSA) vs 70.8 (ORIF) (p= 0.472). Mean qDASH score was 4.50 (rTSA) vs 11.0 (ORIF) (p= 0.025). Mean forward flexion range was 143° (rTSA) vs 109° (ORIF) (p< 0.001). Mean abduction range was 135° (rTSA) vs 110° (ORIF) (p= 0.025). There was a higher number of complications observed for ORIF (3) than rTSA (1) (p= 0.297) and a higher number of re-operations for ORIF (3) than rTSA (1) (p= 0.297), which was not statistically significant.ConclusionrTSA appears to yield a slower recovery at 3 months but a better outcome at 2 years. It is a promising treatment for geriatrics with three- and four-part proximal humerus fractures aiming for a better long-term functional outcome.