<p>The Section for Skeletal Trauma and Sports Injuries of the European Society for Trauma and Emergency Surgery (ESTES) has reached a consensus among European countries in the treatment of proximal humerus fractures in a working group. As a result the ESTES recommendations on proximal humerus fractures in the elderly were published in 2021. The various treatment options and algorithms for this are now described in more detail and the procedures were explained in several related specialist articles. The recommendations include conservative and four possible surgical treatment options (ORIF, nailing, hemi- and total inverse arthroplasty). This article deals with hemi- and total inverse arthroplasty. Reverse total shoulder arthroplasty (RTSA) has emerged as a key treatment for complex proximal humerus fractures in elderly patients. It offers significant advantages in restoring function, alleviating pain, and providing durable outcomes compared to alternative approaches. Despite challenges related to implant complications and surgical expertise, ongoing advancements in technology and techniques continue to improve its effectiveness. With the rising incidence of complex fractures, RTSA is expected to play an increasingly vital role in maintaining the quality of life in aging populations.</p>