Proximal humerus fragility fractures are hard to treat because of comminution and poor bone stock. AVN is common with glenohumeral fracture-dislocation. Hemiarthroplasty (and standard total shoulder arthroplasty, TSA) is unreliable because of its dependence on tuberosity healing. rTSA is recommended for fractures in patients >70 years with severely comminuted fractures, a high likelihood of head AVN, and poor tuberosity bone quality (osteoporosis or comminution).