title: Intermediate-term outcome of hemiarthroplasty for comminuted proximal humerus fractures.
abstract: BACKGROUND
  The purpose of this study was to evaluate the outcome of hemiarthroplasty for comminuted proximal humerus fractures and to verify the risk factors for functional and radiologic outcomes.
  
  
  METHODS
  We treated 29 comminuted proximal humerus fractures by hemiarthroplasty with a low-profile prosthesis and a bone block graft, with an average follow-up period of 53.9 (24-119) months. The patients' mean age at surgery was 71.7 (52-85) years. We evaluated visual analog scale (VAS) scores for pain and satisfaction, active range of motion, modified University of California-Los Angeles (UCLA) score, and shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score. Radiographs were checked for stem position, loosening, and tuberosity union. The statistical evaluation was conducted to compare 2 demographics.
  
  
  RESULTS
  The mean VAS score was 2.1 (0-5) for pain and 8.0 (4-10) for satisfaction. Mean active forward flexion was 125° (90°-170°); external rotation, 42° (25°-70°); and internal rotation, at T11 (T7-L2). The mean modified UCLA score was 20 (12-30), and the mean QuickDASH score was 25 (12-38). All stems were stable without any loosening. All tuberosities were united except 2 tuberosity absorptions.
  
  
  CONCLUSIONS
  Patients older than 70 years and patients with chronic debilitating disease, >5-mm displacement of the prosthetic head from the glenoid, and a critical shoulder angle of >38° showed significantly poorer clinical outcome.
  
  
  CONCLUSIONS
  Low-profile hemiarthroplasty with bone block graft had unique advantages for tuberosity union. During surgery, good prosthetic positioning with respect to the anatomic axis of the glenoid and critical shoulder angle (>38°) were essential. However, age (>70 years) and systemic comorbidity showed poor clinical outcome. These factors should be considered in standardizing the clinical results.
authors: Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea.
authors: Yeong Kyoon
authors: YK
authors: Park
authors: Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Republic of Korea.
authors: Sae Hoon
authors: SH
authors: Kim
authors: Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea. Electronic address: ohjh1@snu.ac.kr.
authors: Joo Han
authors: JH
authors: Oh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation; D005260:Female; D018460:Fractures, Comminuted / Q000601:surgery*; D062785:Hemiarthroplasty; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Fracture; bone block graft; comminuted; hemiarthroplasty; low-profile prosthesis; proximal humerus