Hemiarthroplasty For 4-Part Fractures Of The Proximal Humerus: Is It A Good Treatment Option?

Abstract

Objective: We examined the clinical, functional and radiological outcomes in patients 65 years and older who underwent primary shoulder hemiarthroplasty for a 4-part acute fracture of the proximal humerus, and evaluated efficacy of treatment, patient satisfaction and our procedural deficiencies. Patients and Methods: Eighteen patients were treated with primary hemiarthroplasty for acute proximal humerus Neer type-IV fracture. During follow-up, active forward elevation, abduction, internal/external rotation of the shoulder were assessed. The assessments were based on the Constant-Murley Shoulder Score (CMSS), Simple Shoulder Test Score (SSTS), Oxford Shoulder Score (OSS), scales of University of California and Los Angeles (UCLA). Abduction strength was measured by a myometer and VAS scores were measured for pain and disability. Radiographically, Acromiohumeral Distance (AHD) and Humeral Head-Greater Tuberosity Distance (HHGTD) were assessed, examining presence of union and displacement in the tuberosities. Mean follow-up was 32,8 months. Results: During last follow-up, the mean CMSS was 60,1 (range, 24-77); SSTS, 6,5 (range, 0-10) ; OSS, 25,6 (range, 10-36) and UFSS, 25,2 (range, 16-33). The mean VAS score was 2,6. The mean AHD and HHGTD, on the operated side were 11,7 mm (range, 5– 38 mm) and18,6 mm (range, 8– 29 mm) respectively. Our rate of union of the tuberosity was 89%. Conclusions: PHA surgery performed according to specific principles in the treatment of Neer type IV proximal humeral fractures particularly of fractures in patients who are older than 65 years of age and cannot undergo osteosynthesis for osteoporosis is a reliable surgical treatment, maintaining the shoulder level and relieving the pain as well as allowing acceptable and adequate range of motion for daily activities.