Abstract
Introduction:
The treatment of 3- or 4-part proximal humeral fractures in elderly can be carried out with hemiarthroplasty. Also hemiarthroplasty has performed for failed osteosynthesis or conservative treatment in Japan. However the secondary hemiarthroplasty has poor clinical outcome. The aim of this study was to compare the clinical outcomes of primary and secondary hemiarthroplasty for proximal humeral fractures.
Materials and Methods:
Between March 2004 and January 2013, twenty-four shoulders in 23 patients (22 females, 1 male) with proximal humeral fractures and fracture dislocations underwent hemiarthroplasty. The mean age was 75.6 years and the average follow-up period was 25.6 months (range 3 to 108 months). Eighteen shoulders in 17 patients were treated primary with hemiarthroplasty (primary group). Six shoulders in 6 patients were treated with hemiarthroplasty after other treatments had failed (secondary group). All patients were evaluated with the Japan Orthopaedic Association shoulder scoring system (JOA score) and range of motion.
Results:
The mean JOA score was 66.7 points in primary group and 50.6 points in secondary group. Patients in primary group had significantly better score than secondary group (p < 0.05). At the final follow-up, the mean flexion angle was 81.4 degrees in primary group and 55.0 degrees in secondary group. The mean abduction angle was 79.7 degrees in primary group and 46.7 degrees in secondary group. The mean external rotation angle was 16.1 degrees in primary group and 5.0 degrees in secondary group. There was a significant difference in abduction angle between primary and secondary group (p < 0.05). On the other hand there was no significant difference in flexion and external rotation angle between primary and secondary group (p = 0.10, 0.03).
Conclusions:
In this study primary group demonstrated good clinical results rather than in secondary group. Secondary hemiarthroplasty for failed early treatment is technically difficult. Important factors for secondary hemiarthroplasty include the reconstruction of tuberosities and technique to treat soft tissues such as deltoid gently.
