Abstract:
Objective: We examined the clinical, functional and radiological
outcomes in patients 65 years and older who underwent primary shoulder
hemiarthroplasty for a 4-part acute fracture of the proximal humerus, and
evaluated efficacy of treatment, patient satisfaction and our procedural
deficiencies.
Patients and Methods: Eighteen patients were treated with primary
hemiarthroplasty for acute proximal humerus Neer type-IV fracture.
During follow-up, active forward elevation, abduction, internal/external
rotation of the shoulder were assessed. The assessments were based on
the Constant-Murley Shoulder Score (CMSS), Simple Shoulder Test Score
(SSTS), Oxford Shoulder Score (OSS), scales of University of California
and Los Angeles (UCLA). Abduction strength was measured by a myometer and VAS scores were measured for pain and disability. Radiographically,
Acromiohumeral Distance (AHD) and Humeral Head-Greater Tuberosity
Distance (HHGTD) were assessed, examining presence of union and
displacement in the tuberosities. Mean follow-up was 32,8 months.
Results: During last follow-up, the mean CMSS was 60,1 (range, 24-77);
SSTS, 6,5 (range, 0-10) ; OSS, 25,6 (range, 10-36) and UFSS, 25,2 (range,
16-33). The mean VAS score was 2,6. The mean AHD and HHGTD, on the
operated side were 11,7 mm (range, 5– 38 mm) and18,6 mm (range, 8– 29
mm) respectively. Our rate of union of the tuberosity was 89%.
Conclusions: PHA surgery performed according to specific principles in
the treatment of Neer type IV proximal humeral fractures particularly of
fractures in patients who are older than 65 years of age and cannot undergo
osteosynthesis for osteoporosis is a reliable surgical treatment, maintaining
the shoulder level and relieving the pain as well as allowing acceptable and
adequate range of motion for daily activities.
