Abstract
Prosthetic replacement of the humeral head for fracture remains an operative challenge to even the most experienced orthopaedic surgeon. Although most fractures of the proximal humerus are minimally displaced and treated conservatively, more complex fractures require operative intervention. In this respect, the four-part proximal humerus fracture and fracture-dislocation have been difficult to evaluate and manage. Results from conservative treatment have been consistently unsatisfactory while results from surgery have been more variable with some series reporting satisfactory results.
Treatment options for four-part fractures and fracturedislocations of the proximal humerus fractures include non-operative management, open reduction internal fixation, and humeral head replacement. Because of the poor results with non-operative, resection arthroplasty, and internal fixation, Neer in 1951 introduced prosthetic arthroplasty with tuberosity reconstruction for these complex fractures. Many reports in the literature have documented the successful results of this procedure. In our series of 65 shoulders there were 82% satisfactory results, 97% pain relief, and 85% good functional results. Therefore, prosthetic replacement of acute displaced fractures is technically demanding but offers a predictive result of a pain-free shoulder and functional motion through aggressive rehabilitation. Our goals in this video are to provide stepwise, comprehensive information on the techniques and guidelines for humeral head replacement in the treatment of complex proximal humerus fractures. Careful preoperative planning, patient evaluation, imaging, meticulous operative techniques, and a closely supervised rehabilitation program are necessary to produce a successful functional shoulder after prosthetic reconstruction.
The abstracts were prepared by Mrs Dorothy L. Granchi, Course Coordinator. Correspondence should be addressed to her at PMB 295, 8000 Plaza Boulevard, Mentor, Ohio 44060, USA.
