Most of the minimally displaced proximal humerus fractures in people > 65 years age will unite uneventfully ant the outcomes will be good. However sometimes these fractures are moderately to severely displace and may be accompanied with a head dislocation.
The bone of contention is the highly comminuted and displaced fractures, which pose a significant challenge for the treating physician
Recent literature suggests that in elderly age group, the displaced proximal humerus fractures can also be treated conservatively with outcomes that are comparable to those of a shoulder hemi replacement. What that means it that the average shoulder flexion attained will be around 90-100 degrees in both the scenarios. Sometimes the fractures that are treated non-operatively will not unite. Those fractures will then have to be operated upon and either replaced or fixed with plate etc.
A word of caution with reverse shoulder replacement is that if it fails sometime in the future, the revision is fraught with many complications. Sometimes even a hemi replacement fails and may need to be converted to a reverse shoulder replacement which again has a very high complication rate. So the path to reverse shoulder replacement, although rewarding should be chosen carefully only after giving a good thought to the potential risks ahead