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J Shoulder Elbow Surg. 2017 Jan;26(1):85-91. doi: 10.1016/j.jse.2016.05.008. Epub 2016 Aug 2.

Intermediate-term outcome of hemiarthroplasty for comminuted proximal humerus fractures.

Author information

1
Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea.
2
Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Republic of Korea.
3
Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea. Electronic address: ohjh1@snu.ac.kr.

Abstract

BACKGROUND:

The purpose of this study was to evaluate the outcome of hemiarthroplasty for comminuted proximal humerus fractures and to verify the risk factors for functional and radiologic outcomes.

MATERIALS AND METHODS:

We treated 29 comminuted proximal humerus fractures by hemiarthroplasty with a low-profile prosthesis and a bone block graft, with an average follow-up period of 53.9 (24-119) months. The patients' mean age at surgery was 71.7 (52-85) years. We evaluated visual analog scale (VAS) scores for pain and satisfaction, active range of motion, modified University of California-Los Angeles (UCLA) score, and shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score. Radiographs were checked for stem position, loosening, and tuberosity union. The statistical evaluation was conducted to compare 2 demographics.

RESULTS:

The mean VAS score was 2.1 (0-5) for pain and 8.0 (4-10) for satisfaction. Mean active forward flexion was 125° (90°-170°); external rotation, 42° (25°-70°); and internal rotation, at T11 (T7-L2). The mean modified UCLA score was 20 (12-30), and the mean QuickDASH score was 25 (12-38). All stems were stable without any loosening. All tuberosities were united except 2 tuberosity absorptions.

DISCUSSION:

Patients older than 70 years and patients with chronic debilitating disease, >5-mm displacement of the prosthetic head from the glenoid, and a critical shoulder angle of >38° showed significantly poorer clinical outcome.

CONCLUSION:

Low-profile hemiarthroplasty with bone block graft had unique advantages for tuberosity union. During surgery, good prosthetic positioning with respect to the anatomic axis of the glenoid and critical shoulder angle (>38°) were essential. However, age (>70 years) and systemic comorbidity showed poor clinical outcome. These factors should be considered in standardizing the clinical results.

KEYWORDS:

Fracture; bone block graft; comminuted; hemiarthroplasty; low-profile prosthesis; proximal humerus

PMID:
27496353
DOI:
10.1016/j.jse.2016.05.008
[Indexed for MEDLINE]

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