Early management of proximal humeral fractures with hemiarthroplasty

Abstract

We performed a comprehensive systematic review of the literature to examine the role of hemiarthroplasty in the early management of fractures of the proximal humerus. In all, 16 studies dealing with 810 hemiarthroplasties in 808 patients with a mean age of 67.7 years (22 to 91) and a mean follow-up of 3.7 years (0.66 to 14) met the inclusion criteria. Most of the fractures were four-part fractures or fracture-dislocations. Several types of prosthesis were used. Early passive movement on the day after surgery and active movement after union of the tuberosities at about six weeks was described in most cases. The mean active anterior elevation was to 105.7 degrees (10 degrees to 180 degrees) and the mean abduction to 92.4 degrees (15 degrees to 170 degrees). The incidence of superficial and deep infection was 1.55% and 0.64%, respectively. Complications related to the fixation and healing of the tuberosities were observed in 86 of 771 cases (11.15%). The estimated incidence of heterotopic ossification was 8.8% and that of proximal migration of the humeral head 6.8%. The mean Constant score was 56.63 (11 to 98). At the final follow-up, no pain or only mild pain was experienced by most patients, but marked limitation of function persisted.

Primary Shoulder Arthroplasty Versus Conservative Treatment for Comminuted Proximal Humeral Fractures: A Systematic Literature Review

“…Our results for the arthroplasty group are similar to the systematic review of Kontakis et al who calculated a mean Constant score of 56.6 for the arthroplasty patients on the basis of eight papers featuring 560 patients [10]. We included the same six studies, but did not include the two studies with a relative Constant score (expressed as a percentage of the Constant score of the opposite shoulder) as the outcome measure, because these are higher than the normal Constant score.…”

Surgical Treatment of Neer Group VI Proximal Humeral Fractures: Retrospective Comparison of PHILOS® and Hemiarthroplasty

“…Hertel's eggshell model provides a possible explanation for this observation [13]. Concerning final malunion, absorption, and nonunion of the greater tuberosity the literature varies from 21% to 53% for primary HA of displaced three-and four-part fractures [5,19,21,22]. We explain our comparatively high incidence of mainly radiographic complications with strict analysis of the greater tuberosity, the acromiohumeral distance, and the complexity of the Neer group VI fractures, which are only partially included in other studies [3,5,19,21,22,27].…”

Reverse total shoulder arthroplasty for acute head-splitting, 3- and 4-part fractures of the proximal humerus in the elderly

“…Nonunion, malunion, and resorption or migration of the greater tuberosity are the most common complications and ultimately lead to inconsistent and mainly disappointing functional results. 1,3,5,12,16,23,28 Therefore, a current trend from hemiarthroplasty toward RTSA is reported for complex humeral fractures in the elderly. 38 RTSA yields better functional outcomes and a lower complication rate than hemiarthroplasty in the treatment of complex fractures of the proximal humerus in the elderly.…”