title: Large metaphyseal volume hemiprostheses for complex fractures of the proximal humerus.
abstract: BACKGROUND
  Results of hemiarthroplasty after acute complex proximal humerus fractures are controversial. The main problem is the fixation and healing of the greater tuberosity (GT). To address this problem a hemiarthroplasty with a large metaphyseal volume was designed and introduced.
  
  
  METHODS
  Thirty hemiarthroplasties were implanted for acute, complex, proximal humeral fractures in 30 consecutive patients (average age: 63.3 years; range, 41-78). One patient was lost; 2 patients could only be interviewed telefonically. Two patients had to be revised because of secondary displacement of the GT within the first 2 postoperative years. The remaining 25 patients were assessed clinically, radiographically, and with computer tomography (CT) imaging after a mean of 25 months (range, 24-29).
  
  
  RESULTS
  Greater tuberosity healed in situ in 23 patients. In 12 cases, CT documented severe resorption of GT without displacement of a measurable bone fragment and an intact clinical cuff function with a radiographically preserved acromio-humeral distance. The mean Constant score was 59 points (range, 26-81), the mean relative Constant score 75% (range, 31-100). The mean anterior elevation was 117° (range, 45-160). The mean subjective shoulder value was 70% (range, 25-98). In 4 cases (14%), tuberosity dislocation occurred which was associated with an increase of fatty infiltration and poor result.
  
  
  CONCLUSIONS
  The 2-year results with a large metaphyseal volume fracture-prosthesis showed good to excellent results, with a failure rate of 14%. Substantial resorption of the greater tuberosity was frequent, but was not associated with functional incompetence of the rotator cuff. The overall results obtained justify its continued use.
authors.affiliation: Department of Orthopaedics, University of Zurich, Balgrist University Hospital, Zürich, Switzerland. Electronic address: sandro.fucentese@balgrist.ch.
authors.forename: Sandro F
authors.initials: SF
authors.lastname: Fucentese
authors.affiliation: Department of Radiology, University of Zurich, Balgrist University Hospital, Zürich, Switzerland.
authors.forename: Reto
authors.initials: R
authors.lastname: Sutter
authors.affiliation: Department of Orthopaedics, University of Zurich, Balgrist University Hospital, Zürich, Switzerland.
authors.forename: Fabian
authors.initials: F
authors.lastname: Wolfensperger
authors.affiliation: Department of Orthopaedics, University of Zurich, Balgrist University Hospital, Zürich, Switzerland.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Jost
authors.affiliation: Department of Orthopaedics, University of Zurich, Balgrist University Hospital, Zürich, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Gerber
mesh_terms: D000328:Adult; D000368:Aged; D018771:Arthralgia / Q000145:classification / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D062785:Hemiarthroplasty / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D006811:Humerus / Q000000981:diagnostic imaging / Q000601:surgery; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D012086:Reoperation; D012783:Shoulder Dislocation / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Shoulder; hemiarthroplasty; large metaphyseal volume; prosthesis; proximal humerus fracture