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Complex proximal humeral fractures in elderly patients are increasingly treated with primary reverse total shoulder arthroplasty. Many surgeons use cerclage sutures for tuberosity fixation in reverse total shoulder arthroplasty for proximal humeral fractures. In this study, we hypothesized that sutures fixated with a tensioning device would achieve higher initial fixation stability of the tuberosities compared with manually knotted cerclage sutures in a biomechanical model. A 4-part fracture was created in 7-paired human cadaver proxima