Skip to main content
Top
Published in: MUSCULOSKELETAL SURGERY 1/2014

01-04-2014 | Original Article

Shoulder hemiarthroplasty for complex humeral fractures: a 5 to 10-year follow-up retrospective study

Authors: M. Giovale, T. Mangano, E. Rodà, I. Repetto, P. Cerruti, E. Kuqi, F. Franchin

Published in: MUSCULOSKELETAL SURGERY | Special Issue 1/2014

Login to get access

Abstract

Background

Shoulder hemiarthroplasty is considered a standard treatment in case of complex proximal humeral fractures. However, great variability affects the clinical outcomes. In this work, we examined the clinical and radiographic outcomes in a series of patients treated with hemiarthroplasty for 3- and 4-part humeral fractures and focused on factors affecting the final result.

Materials and methods

In this study, we included 27 patients who had received a shoulder hemiarthroplasty between 2001 and 2005 at our institution. These patients were evaluated at an average of 7.2 years after surgery. All patients were managed within 10 days from trauma by the same surgeon and underwent the same time-scheduled rehabilitation program. Average age at surgery was 71.9 years.

Results

Implant survival was 88.9 %. At the latest follow-up, mean DASH and SST-12 scores were 26.8 and 6.5, respectively. Mean Constant–Murley score was 52.4. Tuberosities complications and reduction in the acromion-humeral distance were negatively related to clinical outcome. Age at surgery displayed a negative correlation with clinical outcome, despite not reaching the statistical significance. This is mainly due to great variability in the elder group of patients.

Conclusions

Shoulder hemiarthroplasty is a useful and effective solution for complex humeral fractures, with good results in the majority of patients. However, outcomes display a great variability in relation to X-ray alterations and age at surgery. A careful attention in patient selection is needed in order to standardize the clinical results associated with this kind of prosthetic implant.
Literature
1.
2.
go back to reference Court-Brown CM, Garg A, McQueen MM (2001) The epidemiology of proximal humeral fractures. Acta Orthop Scand 72:365–371PubMedCrossRef Court-Brown CM, Garg A, McQueen MM (2001) The epidemiology of proximal humeral fractures. Acta Orthop Scand 72:365–371PubMedCrossRef
3.
go back to reference Neer CS II (1970) Displaced proximal humeral fractures—part 1: classification and evaluation. J Bone Jt Surg Am 52:1077–1089 Neer CS II (1970) Displaced proximal humeral fractures—part 1: classification and evaluation. J Bone Jt Surg Am 52:1077–1089
4.
go back to reference Murray IR, Amin AK, White TO et al (2011) Proximal humeral fractures: current concepts in classification, treatment and outcomes. J Bone Jt Surg Br 93-B(1):1–11CrossRef Murray IR, Amin AK, White TO et al (2011) Proximal humeral fractures: current concepts in classification, treatment and outcomes. J Bone Jt Surg Br 93-B(1):1–11CrossRef
5.
go back to reference Bastian JD, Hertel R (2008) Initial post-fracture humeral head ischemia does not predict development of necrosis. J Shoulder Elbow Surg 17:2–8PubMedCrossRef Bastian JD, Hertel R (2008) Initial post-fracture humeral head ischemia does not predict development of necrosis. J Shoulder Elbow Surg 17:2–8PubMedCrossRef
6.
go back to reference Hertel R, Hempfing A, Steihler M et al (2004) Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg 13:427–433PubMedCrossRef Hertel R, Hempfing A, Steihler M et al (2004) Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg 13:427–433PubMedCrossRef
7.
go back to reference Robinson CM, Khan LA, Akhtar MA (2006) Treatment of anterior fracture-dislocations of the proximal humerus by open reduction and internal fixation. J Bone Jt Surg Br 88-B:502–508CrossRef Robinson CM, Khan LA, Akhtar MA (2006) Treatment of anterior fracture-dislocations of the proximal humerus by open reduction and internal fixation. J Bone Jt Surg Br 88-B:502–508CrossRef
8.
go back to reference Noyes MP, Kleinhenz B, Markert RJ et al (2011) Functional and radiographic long-term outcome of hemiarthroplasty for proximal humeral fractures. J Shoulder Elbow Surg 20:372–377PubMedCrossRef Noyes MP, Kleinhenz B, Markert RJ et al (2011) Functional and radiographic long-term outcome of hemiarthroplasty for proximal humeral fractures. J Shoulder Elbow Surg 20:372–377PubMedCrossRef
9.
go back to reference Zyto K, Wallace WA, Frostick SP et al (1998) Outcome after hemiarthroplasty for three- and four-part fractures of the proximal humerus. J Shoulder Elbow Surg 7:85–89PubMedCrossRef Zyto K, Wallace WA, Frostick SP et al (1998) Outcome after hemiarthroplasty for three- and four-part fractures of the proximal humerus. J Shoulder Elbow Surg 7:85–89PubMedCrossRef
10.
go back to reference Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164PubMed Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164PubMed
11.
go back to reference Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29(6):602–608PubMedCrossRef Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29(6):602–608PubMedCrossRef
12.
go back to reference Lippitt SB, Harryman DT, Matsen FA (1993) A practical tool for evaluating function: the simple shoulder test. In: Matsen FA, Fu FH, Hawkins RJ (eds) The shoulder: a balance of mobility and stability. American Academy of Orthopedic Surgeons, Rosemont, pp 501–530 Lippitt SB, Harryman DT, Matsen FA (1993) A practical tool for evaluating function: the simple shoulder test. In: Matsen FA, Fu FH, Hawkins RJ (eds) The shoulder: a balance of mobility and stability. American Academy of Orthopedic Surgeons, Rosemont, pp 501–530
13.
go back to reference Antuña SA, Sperling JW, Cofield RH (2008) Shoulder hemiarthroplasty for acute fractures of the proximal humerus: a minimum five-year follow-up. J Shoulder Elbow Surg 17:202–209PubMedCrossRef Antuña SA, Sperling JW, Cofield RH (2008) Shoulder hemiarthroplasty for acute fractures of the proximal humerus: a minimum five-year follow-up. J Shoulder Elbow Surg 17:202–209PubMedCrossRef
14.
go back to reference Neer CS II (1970) Displaced proximal humeral fractures—part 2: treatment of three and four-part displacement. J Bone Jt Surg Am 52:1090–1103 Neer CS II (1970) Displaced proximal humeral fractures—part 2: treatment of three and four-part displacement. J Bone Jt Surg Am 52:1090–1103
15.
go back to reference Neer CS II, McIlveen SJ (1986) Recent results and technique of prosthetic replacement for four-part proximal humeral fractures. Orthop Trans 10:475 Neer CS II, McIlveen SJ (1986) Recent results and technique of prosthetic replacement for four-part proximal humeral fractures. Orthop Trans 10:475
16.
go back to reference Becker R, Pap G, Machner A et al (2002) Strength and motion after hemiarthroplasty in displaced four-fragment fracture of the proximal humerus: 27 patients followed for 1–6 years. Acta Orthop Scand 73:44–49PubMedCrossRef Becker R, Pap G, Machner A et al (2002) Strength and motion after hemiarthroplasty in displaced four-fragment fracture of the proximal humerus: 27 patients followed for 1–6 years. Acta Orthop Scand 73:44–49PubMedCrossRef
17.
go back to reference Besch L, Daniels-Wredenhagen M, Mueller M et al (2009) Hemiarthroplasty of the shoulder after four-part fracture of the humeral head: a long-term analysis of 34 cases. J Trauma 66:211–214PubMedCrossRef Besch L, Daniels-Wredenhagen M, Mueller M et al (2009) Hemiarthroplasty of the shoulder after four-part fracture of the humeral head: a long-term analysis of 34 cases. J Trauma 66:211–214PubMedCrossRef
18.
go back to reference Boileau P, Krishnan SG, Tinsi L et al (2002) Tuberosity malposition and migration: reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus. J Shoulder Elbow Surg 11:401–412PubMedCrossRef Boileau P, Krishnan SG, Tinsi L et al (2002) Tuberosity malposition and migration: reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus. J Shoulder Elbow Surg 11:401–412PubMedCrossRef
19.
go back to reference Bosch U, Skutek M, Fremerey RW et al (1998) Outcome after primary and secondary hemiarthroplasty in elderly patients with fractures of the proximal humerus. J Shoulder Elbow Surg 7:479–484PubMedCrossRef Bosch U, Skutek M, Fremerey RW et al (1998) Outcome after primary and secondary hemiarthroplasty in elderly patients with fractures of the proximal humerus. J Shoulder Elbow Surg 7:479–484PubMedCrossRef
20.
go back to reference Demirhan M, Kilicoglu O, Altinel L et al (2003) Prognostic factors in prosthetic replacement for acute proximal humerus fractures. J Orthop Trauma 17:188–189CrossRef Demirhan M, Kilicoglu O, Altinel L et al (2003) Prognostic factors in prosthetic replacement for acute proximal humerus fractures. J Orthop Trauma 17:188–189CrossRef
21.
go back to reference Dimakopoulos P, Potamitis N, Lambiris E (1997) Hemiarthroplasty in the treatment of comminuted intraarticular fractures of proximal humerus. Clin Orthop Relat Res 341:7–11PubMed Dimakopoulos P, Potamitis N, Lambiris E (1997) Hemiarthroplasty in the treatment of comminuted intraarticular fractures of proximal humerus. Clin Orthop Relat Res 341:7–11PubMed
22.
go back to reference Goldman RT, Koval KJ, Cuomo F et al (1995) Functional outcome after humeral head replacement for acute three-and four-part proximal humeral fractures. J Shoulder Elbow Surg 4:81–86PubMedCrossRef Goldman RT, Koval KJ, Cuomo F et al (1995) Functional outcome after humeral head replacement for acute three-and four-part proximal humeral fractures. J Shoulder Elbow Surg 4:81–86PubMedCrossRef
23.
go back to reference Gronhagen CM, Assaszadegan H, Révay SA et al (2007) Medium-term results after primary hemiarthroplasty for comminute proximal humerus fractures: a study of 46 patients followed up for an average of 4.4 years. J Shoulder Elbow Surg 16:766–773PubMedCrossRef Gronhagen CM, Assaszadegan H, Révay SA et al (2007) Medium-term results after primary hemiarthroplasty for comminute proximal humerus fractures: a study of 46 patients followed up for an average of 4.4 years. J Shoulder Elbow Surg 16:766–773PubMedCrossRef
24.
go back to reference Mighell M, Kolm G, Collinge C et al (2003) Outcomes of hemiarthroplasty for fractures of the proximal humerus. J Shoulder Elbow Surg 12:569–577PubMedCrossRef Mighell M, Kolm G, Collinge C et al (2003) Outcomes of hemiarthroplasty for fractures of the proximal humerus. J Shoulder Elbow Surg 12:569–577PubMedCrossRef
25.
go back to reference Robinson CM, Page RS, Hill RM et al (2003) Primary hemiarthroplasty for treatment of proximal humeral fractures. J Bone Jt Surg Am 85:1215–1223CrossRef Robinson CM, Page RS, Hill RM et al (2003) Primary hemiarthroplasty for treatment of proximal humeral fractures. J Bone Jt Surg Am 85:1215–1223CrossRef
26.
go back to reference Esen E, Dogramacı Y, Gultekin S et al (2009) Factors affecting results of patients with humeral proximal end fractures undergoing primary hemiarthroplasty: a retrospective study in 42 patients. Injury 40:1336–1341PubMedCrossRef Esen E, Dogramacı Y, Gultekin S et al (2009) Factors affecting results of patients with humeral proximal end fractures undergoing primary hemiarthroplasty: a retrospective study in 42 patients. Injury 40:1336–1341PubMedCrossRef
27.
go back to reference Liu J, Li SH, Cai ZD et al (2011) Outcomes and factors affecting outcomes, following shoulder hemiarthroplasty for proximal humeral fracture repair. J Orthop Sci 16(5):565–572PubMedCrossRef Liu J, Li SH, Cai ZD et al (2011) Outcomes and factors affecting outcomes, following shoulder hemiarthroplasty for proximal humeral fracture repair. J Orthop Sci 16(5):565–572PubMedCrossRef
28.
go back to reference Kralinger F, Schwaiger R, Wambacher M et al (2004) Outcome after primary hemiarthroplasty for acute fracture of the head of the humerus. A retrospective multicenter study of 167 patients. J Bone Jt Surg Br 86:217–219CrossRef Kralinger F, Schwaiger R, Wambacher M et al (2004) Outcome after primary hemiarthroplasty for acute fracture of the head of the humerus. A retrospective multicenter study of 167 patients. J Bone Jt Surg Br 86:217–219CrossRef
29.
go back to reference Muldoon MP, Cofield RH (1998) Complications of humeral head replacement for proximal humeral fractures. Instr Course Lect 47:15–24 Muldoon MP, Cofield RH (1998) Complications of humeral head replacement for proximal humeral fractures. Instr Course Lect 47:15–24
30.
go back to reference Prakash U, McGurty DW, Dent JA (2002) Hemiarthroplasty for severe fractures of the proximal humerus. J Shoulder Elbow Surg 11:428–430PubMedCrossRef Prakash U, McGurty DW, Dent JA (2002) Hemiarthroplasty for severe fractures of the proximal humerus. J Shoulder Elbow Surg 11:428–430PubMedCrossRef
31.
go back to reference Wretenberg P, Ekelund A (1997) Acute hemiarthroplasty after proximal humerus fracture in old patients. A retrospective evaluation of 18 patients followed for 2–7 years. Acta Orthop Scand 68:121–123PubMedCrossRef Wretenberg P, Ekelund A (1997) Acute hemiarthroplasty after proximal humerus fracture in old patients. A retrospective evaluation of 18 patients followed for 2–7 years. Acta Orthop Scand 68:121–123PubMedCrossRef
Metadata
Title
Shoulder hemiarthroplasty for complex humeral fractures: a 5 to 10-year follow-up retrospective study
Authors
M. Giovale
T. Mangano
E. Rodà
I. Repetto
P. Cerruti
E. Kuqi
F. Franchin
Publication date
01-04-2014
Publisher
Springer Milan
Published in
MUSCULOSKELETAL SURGERY / Issue Special Issue 1/2014
Print ISSN: 2035-5106
Electronic ISSN: 2035-5114
DOI
https://doi.org/10.1007/s12306-014-0319-y

Other articles of this Special Issue 1/2014

MUSCULOSKELETAL SURGERY 1/2014 Go to the issue