Objective: To evaluate the functional results and patient subjective satisfaction of hemiarthroplasty for complex fractures of the proximal humerus

Methods: Forty-one consecutive three and four-part proximal humerus fractures in 40 patients (mean age: 71.3, 28 to 85 years) treated with hemiarthroplasty were retrospectively evaluated at a mean follow-up of 30,5 (12–82) months. Patients were clinically assessed following the Constant scale, and the ability to perform activities of daily living was scored according to the ASES score. The results were compared to the contra-lateral healthy shoulder. The patients activity level was documented pre- and postoperatively following a semi-quantitative scale ranging 1 to 5, and patients gave their subjective opinion on the result.

Results: The mean Constant scores and the mean scores in the ability to perform daily activities were 51.1±18 and 13.7±7 in the injured shoulder and 79.6±9 and 22.6±4 in the opposite, respectively. Pain relief was the most predictable outcome. The activity level decreased from to 3.5 to 3.1. One patient (2.4%) rated subjectively the result as excellent, 12 (29.3%) as good, 19 as fair (46.3%), and 9 patients (22%) as poor. Two patients required revision, one due to periprosthetic fracture who underwent open reduction and internal fixation, and one due to acute greater tuberosity detachement, who was managed with open reattachment.

Discussion: Hemiarthroplasty for complex proximal humeral fractures yields suboptimal objective and subjective results and should be reserved for head-splitting fractures, four-part fractures in patients with low physical demands, and for those cases where an acceptable reduction cannot be obtained.

Background: Although most proximal humerus fractures occur in postmenopausal women and are attributed to osteoporosis, they are usually not considered individually in osteoporotic studies due to their theoretical lower incidence. We hypothesized that proximal humeral fractures patients are among the commonest fractures associated to osteoporosis, and may represent a major cause of functional disability.

Objective: To evaluate the incidence of non-displaced proximal humeral fractures in comparison with other outpatient treated osteoporotic fractures, and to assess their functional impact and on the quality of life perceived by the patients.

Methods: In this multicenter, cross-sectional, prospective study, all osteoporotic fractures in postmenopausal women aged 50 years or older treated non-operatively in 358 trauma centres were recorded during a three month period. The fractures were considered osteoporotic if they were caused by a low-energy trauma. Pathologic fractures were ruled out. The incidence of proximal humeral fractures in relation to other osteoporotic fractures was calculated. Patients were interviewed by telephone six months after the fracture using the Spanish versions of the DASH and EuroQoL 5D questionnaires.

Results: 5762 women (mean age: 73± 7.5 years) were studied. 912 (17.5%) had suffered proximal humeral fractures. Overall, proximal humerus fracture was the most frequent site, after distal radius and vertebral fractures, and was the most common in patients older than 75 years (393 cases, 43.1%). The mean DASH score was 26,62±17,9. The EuroQoL 5D questionnaire showed that 67,3% had pain or discomfort, and disclosed significant reductions in the functional capacity, especially concerning problems with self care (44,5%), performing usual activities (56,5%), and anxiety or depression (32,7%).

Discussion: Non-displaced proximal humeral fractures are among the most common fractures associated to osteoporosis, and constitute the most frequent non-operatively treated fracture in patients older than 75 years. Even if they are non-displaced, they can be a major cause of functional disability, and result in a reduction in the patient’s subjective perception of health.

We prospectively evaluated 61 patients treated arthroscopically for anterior instability of the shoulder at a mean follow-up of 44.5 months (24 to 100) using the Rowe scale. Those with post-operative dislocation or subluxation were considered to be failures. Logistic regression analysis was used to identify patients at increased risk of recurrence in order to develop a suitable selection system.

The mean Rowe score improved from 45 pre-operatively to 86 at follow-up (p < 0.001). At least one episode of post-operative instability occurred in 11 patients (18%), although their stability improved (p = 0.018), and only three required revision. Subjectively, eight patients were dissatisfied. Age younger than 28 years, ligamentous laxity, the presence of a fracture of the glenoid rim involving more than 15% of the articular surface, and post-operative participation in contact or overhead sports were associated with a higher risk of recurrence, and scored 1, 1, 5 and 1 point, respectively. Those patients with a total score of two or more points had a relative risk of recurrence of 43% and should be treated by open surgery.