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. 2013 Jun 11;48(1):29-35.
doi: 10.1016/j.rboe.2013.04.003. eCollection 2013 Jan-Feb.

Treatment of complex acute proximal humerus fractures using hemiarthroplasty

Bruno Lobo Brandão  1 , Marcus Vinicius Galvão Amaral  2 , Marcio Cohen  2 , Rickson Guedes de Moraes Correia  2 , Carlos Henrique Gazineu Abdenur  3 , Martim Teixeira Monteiro  4 , Geraldo Rocha Motta Filho  5   2
Affiliations

Treatment of complex acute proximal humerus fractures using hemiarthroplasty

Bruno Lobo Brandão et al. Rev Bras Ortop. .

Abstract

Objective: Evaluate the clinical and radiological results of hemiarthroplasty for treatment of complex proximal humerus fractures.

Methods: Sixty-seven patients were included, with follow-up of 12 to 62 months. Mean age was 65 years (44 to 88), and 47 patients were female (70%). Clinical assessment was performed using the University of California Los Angeles score (UCLA) and measurement of range of motion (ROM) according to the American Academy of Orthopaedic Surgeons criteria. A standardized radiological evaluation was conducted, with special attention to healing and position of tuberosities. Patients were divided into two groups: A (anatomical healing of tuberosities) and B (without anatomical healing of tuberosities). Statistical analyses were performed using the t test. Level of significance was set at p < 0.05.

Results: Considering the entire sample, the mean UCLA score was 26 points, with 8 points for pain and 64 patients subjectively satisfied (96%). The mean values for active ROM were 104° of forward flexion and 36° of external rotation. In group A, with 33 patients, we found a mean of 122° forward flexion and 29.5 points on UCLA. In group B the mean forward flexion were 87° and 22.7 points for UCLA. Comparing these parameters in the two groups, we found statistically significant differences for both forward flexion (p < 0.0001) and UCLA. (p < 0.0001).

Conclusion: We conclude that hemiarthroplasty for treatment of complex proximal humerus fractures has a low incidence of complications and a high subjective satisfaction rate, with favorable results related to pain. A good functional result is less predictable and depends on anatomical reestablishment of proximal humerus anatomy, particularly healing of the greater tuberosity.

Keywords: Arthroplasty; Humeral fractures; Shoulder.

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Figures

Fig. 1
Fig. 1
Variation in active anterior flexion according to different authors.
Fig. 2
Fig. 2
Positioning of the test prosthesis using the positioning jig.
Fig. 3
Fig. 3
Sequence showing the binding of the tubercles, associated with bone grafting.
Fig. 4
Fig. 4
Technique for measuring the height of the greater tubercle.
Fig. 5
Fig. 5
Results according to UCLA score.
Fig. 6
Fig. 6
Comparison of UCLA score between groups A and B.
Fig. 7
Fig. 7
Comparison of active anterior flexion between groups A and B.
Fig. 8
Fig. 8
Example of patient with good radiological and clinical results.
See this image and copyright information in PMC

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