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.