In this report a novel surgical treatment of proximal humerus fractures with shoulder hemiarthroplasty through an anterolateral acromial approach is presented. This access allows a drastic reduction of the risk of iatrogenic neurovascular complications and was developed to allow less invasive treatment of proximal humerus fractures with an easy control of the tuberosities which are often dislocated. Furthermore, this access allows the conservation of the anatomical integrity of the rotator cuff muscle which is fundamental in older patients. After removal of the humeral head, by this antero-lateral approach a better visibility of glenoid cavity is achieved thus allowing a more correct prosthesis components placement and a easier fixation of the tuberosity around the prosthesis using strong non-absorbable suture.

Over a 2-years period, 24 patients (age 68.9, range 53–83, 17 females and 7 males) with either displaced 4-parts fractures, according to Neer classification, or fracturedislocations of the humeral proximal third, were surgically treated trought a shoulder hemiarthroplasty with direct antero-lateral acromial approach. Clinical and functional assessments were performed at 3, 6, 12, and 18 months including the determination of the Constant Score, the radiographic assessment in an antero-posterior and axillary view of the humerus, a photographic documentation of the injured shoulder function as compared with the non-injured extremity and the assessment of the upper limb motion with a motion analysis system.

An increase in mean Constant Score and ranges of motion was observed over the follow-up-period. At 12-months follow-up the Constant Score was 62.2 points (range 41–91) out of a total of 100. Patients at 12 months showed a mean active flexion of the shoulder in the sagittal plane of 45.8 degrees (range 19.1–89.4); the mean active abduction was 49.4 degrees (range 26.1–90.8) with forearm turned down and 57.1 degrees (range 16.7–119.2) with forearm turned up; the range of rotation was 30.9 degrees (range 26.2–35.6). Nevertheless, all patients were able to perform the activity with a relatively pain-free shoulder.

The results obtained in the present study are comparable with the literature data, where other surgical approaches were used. Due to its conservative features, the presented surgical approach may represent a good alternative in shoulder hemiarthroplasty.