Shoulder hemiarthroplasty for the treatment of three- and four-part fractures of the proximal humerus
Cem Esenyel Zeki, Kamil Çetiner, Ayhan Kara Nedim
Bezm-i Alem Valide Sultan Vakıf Gureba Eğitim ve Araştırma Hastanesi Ortopedi ve Travmatoloji Kliniği
Keywords: Arthroplasty, replacement/methods; humeral fractures/ classification; joint prosthesis; prosthesis design; range of motion, articular; shoulder fractures/surgery; shoulder joint/surgery.
Objectives: We evaluated the results of hemiarthroplasty in the treatment of three- or four-part proximal humeral fractures.
Patients and methods: Eleven patients (8 females, 3 males; mean age 64 years; range 38 to 75 years) underwent hemiarthroplasty for acute proximal humeral fractures. One patient had bilateral involvement. The ages of all the patients but one were above 60 years (91%). According to the 4-segment classification system proposed by Neer, there were five type III fractures (41.8%) and seven type IV fractures (58.3%). Surgery was performed within 20 days (mean 11 days) after fracture occurrence. Clinical assessment was made with the use of the Constant scoring system. The mean follow- up was 21 months (range 12 to 36 months).
Results: Ten patients (91%) had minimal or no pain, whereas one patient (9%) complained of moderate pain. The mean Constant score was 70.5. The mean forward elevation was 105 degrees, external rotation was 28 degrees, and internal rotation was to the second lumbar vertebra. According to the Constant scores, the results were excellent and good in four patients (33.3%), fair in seven patients (58.3%), and poor in one patient (8.3%). Shoulder stability was normal in all the patients. Radiographically, there was no evidence of loosening of the prosthesis. Union of all tubercula was obtained without any displacement. One patient developed grade II heterotopic ossification.
Conclusion: Shoulder hemiarthroplasty is a reliable surgical procedure for the treatment of both four-part fractures and three-part fractures associated with severe osteopenia, resulting in satisfactory shoulder function and pain relief.