SHOULDER HEMIARTHROPLASTY FOR THE MANAGEMENT OF NEGLECTED FRACTURES AND FRACTURE-DISLOCATIONS OF THE PROXIMAL HUMERUS

Abstract

Aim: Displaced intrarticular fractures and fracture-dislocations of the proximal humerus usually need operative treatment. The results of shoulder hemiartroplasty for the treatment of neglected fractures and fracture-dislocations are presented.

Material – Method: 9 shoulder hemiartroplasties with modular head was used for the treatment of 5 neglected comminuted fractures and 4 fracture-dislocations of the proximal humerus. They were 5 females and 4 males with a mean age of 58 years, which were followed-up for a mean period of 4 years. The time between the injury and the operation varied from 2 to 8 months. The main indications was pain, loss of shoulder movement in relatively young patients. The tuberosities were found and extensively mobilized. The prosthesis was inserted with cement and the tuberosities were reattached to the shaft.

Results: Main follow up was 4 years (2–8). The results were assessed according the modified UCLA score and were found excellent in 2, satisfactory in 4 and poor in z cases. Pain has improved in 7 cases and the mean postoperative elevation was 90? (20?–130?). External and internal rotation was significally improved. 5 patients presented satisfactory muscle strength and were able to perform satisfyingly the daily activities. Constant score rated from 50 to 80.

The presence of a dislocation did not affect the final outcome. On the contrary the displacement of the tuberosities was decisive, and it was combined with greater scaring of the soft tissues and greater loss of motion. One patient developed transient palsy of the axillary nerve and another aseptic loosening of the prosthesis 7 years postoperatively.

Conclusions: The success of the hemiartroplasty is based on the proper patient selection, the good operative technique and the meticulous postoperative rehabilitation. The retroversion, the height of the prosthesis and the correct balance of the soft tissues are of critical importance in the achievement of a good postoperative result. The tissue scaring, the tuberosities displacement and the rotator cuff lesions create such conditions that place these patients in the limited goal group, as introduced by Neer. The results of this group are considerably inferior to those treated soon after the injury. For this reason if indicated the prosthesis should be used at the first stage and not after the failure of the conservative treatment.