Cappellari A, Trovarelli G, Andriolo M, et al. - This study examined the authors' experience with the use of Reverse Total Shoulder Arthroplasty (RTSA) for the treatment of these fractures in the elderly, assessing complications, and functional results. Between June 2005 and December 2017, 91 patients older than 65 were treated with RTSA at the Institute: there were 14 males and 77 females, with a mean age of 76 years (range 65–87 years). This study enrolled 58 fractures (20 Neer 3, 38 Neer 4) and 33 fracture-dislocations (7 Neer 3, 26 Neer 4). The DASH score and Constant score (CS) were applied to record complications and functional outcomes. The data revealed that RTSA effectively treats complex PHFs in the elderly with inadequate bone stock and needing early recovery of autonomy in daily activities. It was noted that the incidence of complications needing revision surgery is low and functional results are satisfactory and predictable.