title: Hemiarthroplasty for proximal humerus fractures in patients with Parkinson's disease.
abstract: BACKGROUND
  Parkinson's disease is a relatively common problem in geriatric patients with an annual incidence rate of 20.5 per 100,000. These patients are at increased risk for falls and resultant fractures. Several reports suggest total shoulder arthroplasty in patients with fractures has a relatively high rate of complications. Whether hemiarthroplasty reduces the rate of complications or improves pain or function is not known.
  
  
  OBJECTIVE
  We therefore determined the ROM, pain, complications, and rate of failure of hemiarthroplasty for management of proximal humerus fractures in patients with Parkinson's disease.
  
  
  METHODS
  We retrospectively reviewed all eight hemiarthroplasties in patients with Parkinson's disease for fracture of the proximal humerus between 1978 and 2005. Seven patients (seven shoulders) had a minimum of 2 years followup (mean, 9.9 years; range, 2-16 years).
  
  
  RESULTS
  Postoperatively, the mean active abduction was 97 degrees , mean external rotation was 38 degrees , and internal rotation was a mean of being able to reach the level of the sacrum. The mean postoperative pain score was 2.5 points (on a scale of 1-5). There was a greater tuberosity nonunion in one patient and a superior malunion of the greater tuberosity in three patients. No patient had revision surgery.
  
  
  CONCLUSIONS
  The benefit of hemiarthroplasty for proximal humerus fractures in patients with Parkinson's disease was marginal with three shoulders in seven patients having moderate to severe persistent pain and limited function postoperatively.
  
  
  METHODS
  Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedics, Wilford Hall Medical Center, Lackland AFB, TX, 78236, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Kryzak
authors.forename: John W
authors.initials: JW
authors.lastname: Sperling
authors.forename: Cathy D
authors.initials: CD
authors.lastname: Schleck
authors.forename: Robert H
authors.initials: RH
authors.lastname: Cofield
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000009:adverse effects / Q000379:methods*; D005260:Female; D017102:Fracture Healing; D017759:Fractures, Malunited; D005599:Fractures, Ununited; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D012785:Shoulder Joint / Q000473:pathology / Q000503:physiopathology / Q000601:surgery
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