Introduction:
Proximal humerus fractures are common, especially in the elderly, and often require surgical intervention to restore function.

Aim:
The study aimed to evaluate the effectiveness of arthroplasty in the treatment of multifragment fractures of the proximal humerus by comparing clinical outcomes of reverse shoulder arthroplasty and osteosynthesis, including functional outcomes, complication rates, postoperative pain, and the need for revision surgery.

Material and methods:
The results were assessed using the Constant-Murley, DASH and visual analogue pain scales. The study was conducted from November 2019 to December 2024 and included 68 patients with complex proximal humerus fractures. All patients had multifragmentary fractures of the Neer 3–4 type.

Results and discussion:
The primary comparative analysis was based on the 12-month follow-up assessment. At this time point, the mean Constant-Murley score in the arthroplasty group was 72.8±6.3 points, compared with 58.4±7.2 points in the osteosynthesis group (p<0.05), while the mean DASH score was 22.3±4.1 and 34.7±5.6 points, respectively. The percentage of patients with good or excellent functional outcomes after arthroplasty reached 82%, while after osteosynthesis, it was only 54%. Pain levels according to the visual analogue scale at the 3-month follow-up were lower in the arthroplasty group (2.1±0.7 points vs. 4.5±1.1 points). The incidence of complications was 18% in the arthroplasty group and 36% in the osteosynthesis group, with repeat surgeries required in 10% and 24% of cases, respectively.

Conclusions:
Arthroplasty was associated with better functional outcomes and lower pain intensity than osteosynthesis during the 12-month follow-up period and may represent a useful surgical option for selected patients with complex proximal humerus fractures.