title: Primary Hemiarthroplasty for Proximal Humeral Fractures in the Elderly: Long-Term Functional Outcome and Social Implications.
abstract: BACKGROUND
  Primary shoulder hemiarthroplasty is an established treatment modality for complex fractures of the proximal humerus. Long-term functional outcome is often disappointing. However, little is known about social implications particularly in the elderly.
  
  
  METHODS
  A single-institution case series of consecutive geriatric patients (age > 70 years) treated with shoulder hemiarthroplasty for complex fractures of the proximal humerus between 1994 and 1997 was analysed. Postoperative morbidity, long-term function, radiological outcome and social implications were evaluated.
  
  
  RESULTS
  Seventy-seven patients fulfilled the study criteria. Median age at the time of operation was 80 years (range 70-93 years). Systemic and local postoperative complications were observed in 8% including 2 patients (3%) with revision surgery. Postoperative mortality was 1%. Forty-eight patients (62%) were available for follow-up (median 49 months, range 25-80 months), 22 (29%) died from causes unrelated to hemiarthroplasty before follow-up and 7 patients (9%) did not attend follow-up examination. Median Constant-Murley score was 41 points (range 17-77 points). Long-term results concerning pain were satisfying. The Oxford shoulder score ranged from 14 to 40 (median 30). Forty-one patients (85%) still lived in their original environment and managed their daily life independently despite poor shoulder function. Four patients (8%) lived in a retirement home and 3 (6%) in a nursery home. Eighty percent of our patients were still able to use public transportation, do the daily shopping and wash their whole body by themselves.
  
  
  CONCLUSIONS
  Most patients managed their daily life independently despite poor shoulder function.
authors.affiliation: Department of Surgery, Stadtspital Triemli, Zurich, Switzerland. michael.dietrich@triemli.stzh.ch.|Department of Surgery, Stadtspital Triemli, Birmensdorferstrasse 497, 8063, Zurich, Switzerland. michael.dietrich@triemli.stzh.ch.
authors.forename: Michael
authors.initials: M
authors.lastname: Dietrich
authors.affiliation: Division of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Meier
authors.affiliation: Department of Surgery, Stadtspital Triemli, Zurich, Switzerland.
authors.forename: Daniela
authors.initials: D
authors.lastname: Zeller
authors.affiliation: Department of Surgery, Stadtspital Triemli, Zurich, Switzerland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Grueninger
authors.affiliation: SportClinic Zurich, Zurich, Switzerland.
authors.forename: Roger
authors.initials: R
authors.lastname: Berbig
authors.affiliation: Department of Surgery, Stadtspital Triemli, Zurich, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Platz
keywords: Elderly; Hemiarthroplasty; Outcome; Shoulder; Social implications