Outcomes, and factors affecting outcomes, following shoulder hemiarthroplasty for proximal humeral fracture repair

Department of Orthopaedics, The Tenth People's Hospital of Shanghai, Tongji University, Shanghai Trauma and Emergency Center, 301 Yanchang Road, Shanghai, 200072, People's Republic of China.
Journal of Orthopaedic Science (Impact Factor: 0.94). 07/2011; 16(5):565-72. DOI: 10.1007/s00776-011-0113-8
Source: PubMed


Hemiarthroplasty has been applied to treat proximal humeral fracture with variable outcomes. The purpose of this retrospective study was to assess factors affecting outcome in patients following hemiarthroplasty for proximal humeral fracture (PHF) repair.
Patients with proximal humeral fractures treated over a 6-year period were included. Indications for hemiarthroplasty were severe three-part fractures associated with osteoporosis; four-part fractures with or without dislocation; splitting of the humeral head, or >45% collapse of the humeral head. Surgery outcome and postoperative complications were main outcome measures in this study.
Thirty-three of 47 patients were included in the final analysis (mean age 64.3 years, range 43-82). Mean postoperative follow-up was 44.4 (range 36-57) months. Postoperative complications (shoulder dislocation, mild shoulder subluxation, heterotopic ossification) occurred in seven patients. Healing of the greater and lesser tubercles was abnormal or poor in 18 patients. These patients had significantly higher pain scores (4.0 ± 1.1 vs. 2.2 ± 1.1) and significantly lower capacities for active lifting (79.3 ± 9.6 vs. 121.7 ± 24.3), external rotation (20.7 ± 3.7 vs. 39.2 ± 10.3), and Neer scores (79.2 ± 5.7 vs. 90.6 ± 3.6) versus patients who exhibited complete healing (all P < 0.001). Patient age, type of surgical approach, and fracture type were not major influencers of outcome.
In conclusion, the healing of the greater and lesser tubercles is the major determinant of outcome following hemiarthroplasty for PHF repair.

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    • "Shoulder hemiarthroplasty is a technically challenging procedure which can predictably restore shoulder-level function in patients with 4-part fractures, some 3-part fractures, fracture dislocations, head-splitting fractures, and impaction fractures of the humeral head with involvement of more than 50% of the articular surface [1] [2] [3] [4]. Early surgical intervention within 2 weeks postinjury, accurate tuberosity reconstruction, and appropriate height and retroversion of the prosthesis are the factors with the greatest impact on functional outcome [5] [6] [7] [8]. "
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    ABSTRACT: Background. The purpose of this study was to report our experience with shoulder hemiarthroplasty in the context of old trauma. Methods. 33 patients with failed treatment for a complex proximal humeral fracture underwent prosthetic hemiarthroplasty. There were 15 men and 18 women with a mean age of 58.1 years. The average period from initial treatment was 14.9 months. Sequelae included 11 malunions, 4 nonunions, 15 cases with avascular necrosis (AVN) and 3 neglected posterior locked dislocations. Follow up investigation included radiological assessment and clinical evaluation using the Constant score and a visual analogue pain scale. Results. After a mean follow up of 82.5 months the median Constant score was 75.7 points, improved by 60% in comparison to preoperative values. Greater tuberosity displacement, large cuff tears and severe malunion were the factors most affected outcome. No cases of stem loosening or severe migration were noted. 60% of the patients were able to do activities up to shoulder level compared with 24% before reconstruction. Conclusions. Late shoulder hemiarthroplasty is technically difficult and the results are inferior to those reported for acute humeral head replacement, nonetheless remains a satisfactory reconstructive option when primary treatment fails.
    Full-text · Article · Jan 2013
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    ABSTRACT: Proximal humerus fractures are common injuries that are increasing in incidence with the aging of the population. While nonoperative treatment of some fracture patterns results in clinical success, other, more displaced and comminuted fractures may require surgery to ensure a successful outcome. It is important to evaluate both patient and fracture characteristics in deciding upon the appropriate type of treatment. Every effort should be made to perform a humeral sparing procedure in younger patients. In the elderly, especially with more complex four-part fractures and fracture dislocations, hemiarthroplasty and reverse total shoulder arthroplasty are indicated to decrease complication rates and improve functional outcomes. In hemiarthroplasties, it is critical to achieve proper implant height and positioning of the tuberosities. For those patients or fractures in which the tuberosities are unlikely to heal or cannot be adequately reconstructed, reverse total shoulder arthroplasty should be considered.
    No preview · Article · Jan 2013 · Current Reviews in Musculoskeletal Medicine
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    ABSTRACT: Proximal humerus fractures are common and most often occur in the elderly, who may also suffer from osteopenia and multiple medical comorbidities. Codman first described these fractures as consisting of four parts: Articular head, greater tuberosity, lesser tuberosity and diaphysis. There are multiple modalities to treat these fractures, with the literature reporting that up to 80% can be effectively managed non-operatively. When surgery is indicated, one of the options is arthroplasty. Knowledge of normal shoulder anatomy is important as accurate reduction and fixation of the tuberosities is vital to a good outcome following arthroplasty for trauma. Hemiarthroplasty for fracture of the proximal humerus was first described by Neer, and has been used for over forty years. The results have demonstrated reliable pain relief but variable self-reported scores and functional outcomes, with dependence on anatomic tuberosity healing for satisfactory results. Reverse total shoulder arthroplasty has recently been introduced for treatment of proximal humerus fractures, demonstrating reliable pain relief and restoration of forward elevation. This review will summarize the available evidence and techniques for arthroplasty for the management of proximal humerus fractures.
    Full-text · Article · Aug 2013 · Minerva Ortopedica e Traumatologica
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