Hemiarthroplasty for humeral four-part fractures for patients 65 years and older: a randomized controlled trial.
BACKGROUND
Four-part fractures of the proximal humerus account for 3% of all humeral fractures and are regarded as the most difficult fractures to treat in the elderly. Various authors recommend nonoperative treatment or hemiarthroplasty, but the literature is unclear regarding which provides better quality of life and function.


OBJECTIVE
We therefore performed a randomized controlled trial to compare (1) function, (2) strength, and (3) pain and disability in patients 65 years and older with four-part humeral fractures treated either nonoperatively or with hemiarthroplasty.


METHODS
We randomly allocated 50 patients to one of the two approaches. There were no differences in patient demographics between the two groups. The Constant-Murley score was the primary outcome measure. Secondary outcome measures were the Simple Shoulder Test, abduction strength test as measured by a myometer, and VAS scores for pain and disability. All patients were assessed at 12 months.


RESULTS
We found no between-group differences in Constant-Murley and Simple Shoulder Test scores at 3- and 12-months followup. Abduction strength was better at 3 and 12 months in the nonoperatively treated group although the nonoperatively treated patients experienced more pain at 3 months; this difference could not be detected after 12 months.


CONCLUSIONS
We observed no clear benefits in treating patients 65 years or older with four-part fractures of the proximal humerus with either hemiarthroplasty or nonoperative treatment.


METHODS
Level I, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
Department of Orthopaedics, Elkerliek Hospital, Helmond, The Netherlands.
Harm W
HW
Boons
Jon H
JH
Goosen
Susan
S
van Grinsven
Job L
JL
van Susante
Corné J
CJ
van Loon
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D004185:Disability Evaluation; D005260:Female; D017102:Fracture Healing; D062785:Hemiarthroplasty / Q000009:adverse effects; D006801:Humans; D008297:Male; D053580:Muscle Strength; D009426:Netherlands; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology; D011859:Radiography; D020127:Recovery of Function; D012782:Shoulder / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012784:Shoulder Fractures / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D000070599:Shoulder Injuries; D013997:Time Factors; D016896:Treatment Outcome