Functional outcome after proximal humeral fractures treated with hemiarthroplasty.
OBJECTIVE
To evaluate functional outcome after hemiarthroplasty for displaced proximal humeral fractures and to review whether prosthesis type, intraoperative technique or previous ipsilateral shoulder surgery could affect the outcome.


METHODS
We reviewed the medical records and radiographs of patients who had undergone hemiarthroplasty for proximal humeral fractures between 1992 and 2000. We identified 45 patients, 39 with acute fractures and 6 with fracture-related complications. One surgeon performed 17 surgeries (38%), and the rest were carried out by 11 other orthopedic surgeons. Using the American Shoulder and Elbow Surgeons Evaluation Form and the Western Ontario Rotator Cuff Index, we evaluated patients who had been followed for at least 2 years for residual shoulder pain, range of motion, strength, stability and function. The senior authors reviewed the radiographs.


RESULTS
The mean age of the patients at presentation was 70 (range 46-95) years. The mean active forward elevation was 87 degrees, abduction 63 degrees and external rotation 22 degrees; the mean internal rotation was to the L2 vertebra. Of the patients, 15% reported severe pain, and 25% were unable to sleep on the affected side. Patients with previous surgeries and those with intraoperative cuff tears were found to have more postoperative pain.


CONCLUSIONS
We conclude that soft tissue status and operative technique play an important role in late postoperative pain and range of motion. Hemiarthroplasty after failed open reduction and internal fixation is associated with inferior results. We were unable to show a difference in long-term outcome related to the prosthesis type.
Division of Orthopedic Surgery, University of Ottawa, Ont.
Salah
S
Fallatah
Geoffrey F
GF
Dervin
Jacques A
JA
Brunet
Anna F
AF
Conway
Heather
H
Hrushowy
D000368:Aged; D000369:Aged, 80 and over; D001178:Arthroplasty / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D000070636:Rotator Cuff Injuries; D012421:Rupture; D012782:Shoulder / Q000000981:diagnostic imaging; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012785:Shoulder Joint / Q000503:physiopathology; D016896:Treatment Outcome