Outcome after primary hemiarthroplasty for fracture of the head of the humerus

Kralinger, Franz; Schwaiger, R.; Wambacher, Markus; Farrell, Eric D.; Menth-Chiari, Wolfgang A.; Lajtai, G.; Hübner, Clemens; Resch, Herbert

doi:10.1302/0301-620x.86b2.14553

Cited by 310 publications

(229 citation statements)

References 13 publications

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“…In recent years, good pain relief has been consistently reported in the literature [10][11][12][13], but the post-operative shoulder range of motion and functional outcomes have been less satisfying [10][11][12]. In a multicentre, retrospective study of 167 patients by Kralinger et al [14], only 41.9 % of the patients demonstrated a postoperative forward elevation of over 90°.…”

Section: Discussionmentioning

confidence: 99%

“…A large number of reports have suggested that the healing status of the greater tuberosity after shoulder arthroplasty is crucial for functional recovery of the shoulder [14][15][16][17][18][19][20][21]. In a study by Tanner and Cofield [22], post-operative displacement of the greater tuberosity was thought to be the most common complication after shoulder arthroplasty for the treatment of proximal humeral fractures.…”

Section: Discussionmentioning

confidence: 99%

“…Several attempts to avoid tuberosity complications after shoulder arthroplasty have been reported, including cerclage fixation, decreased humeral retroversion, placement of a postoperative neutral position brace and delayed post-operative rehabilitation [14,17,19]. The application of bone ingrowth materials is also an approach.…”

Section: Discussionmentioning

confidence: 99%

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Trabecular metal™ shoulder prosthesis in the treatment of complex proximal humeral fractures

Jiang

2013

International Orthopaedics (SICOT)

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Purpose Shoulder arthroplasty is one of the options for the treatment of complex proximal humeral fractures. The purpose of this study was to assess the clinical and radiographic results of the trabecular metal shoulder prosthesis in the treatment of complex proximal humeral fractures. Methods Fifty-one consecutive patients with complex proximal humeral fractures who underwent primary shoulder arthroplasties with the trabecular metal™ prosthesis were enrolled in this study. At the final follow-up appointment, 42 of the patients (82.4 % of the total patients enrolled) were available for both clinical and radiographic evaluation. There were 28 women and 14 men with a mean age of 65.4±10.7 years. The dominant arm was involved in 30 of the cases. According to Neer's classification, there were seven three-part fractures, 27 four-part fractures and eight head-splitting fractures. Additionally, there were 37 hemiarthroplasties and five total shoulder arthroplasties.Results After a mean follow-up of 37.0±8.4 months (range 24-52 months), the average ranges of motion were: 38.6±15.0°f or external rotation, L3 level for internal rotation and 132.3±36.0°for forward elevation. The mean American Shoulder and Elbow Surgeons, visual analogue scale and University of California, Los Angeles scores were 82.1±14.1, 0.4±1.1 and 28.8±5.1, respectively. The post-operative radiographs exhibited an anatomically attached greater tuberosity in 39 of the 42 shoulders. Of the three patients with greater tuberosity complications, as displayed by their radiographs, two were observed with malpositioned tuberosities, while the other greater tuberosity was resorbed. Proximal migration of the prosthesis was observed in all three shoulders with greater tuberosity complications and in two shoulders with an anatomically attached greater tuberosity. No neurovascular injury, infection or prosthetic loosening was identified during the final follow-up appointments.Conclusions Satisfactory results can be expected with the trabecular metal shoulder prosthesis for the treatment of complex proximal humeral fractures. The post-operative radiographs demonstrated an anatomically healed greater tuberosity in 93 % of the patients at a minimum follow-up time of two years.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Trabecular metal™ shoulder prosthesis in the treatment of complex proximal humeral fractures

Jiang

2013

International Orthopaedics (SICOT)

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“…Higher complication rates have been seen in patients who underwent arthroplasty after failure of initial fracture fixation than in those who underwent humeral head replacement as the primary fracture treatment 29 . However, poor results are also seen in patients who undergo primary arthroplasty for the treatment of proximal humeral fractures 30,31 , particularly with regard to tuberosity malunion or nonunion 32,33 . Percutaneous pinning may offer the advantages of excellent reduction and union rates, preservation of rotator cuff function, and a lack of intra-articular destruction, allowing better results after revision surgery.…”

Section: Discussionmentioning

confidence: 99%

Intermediate Outcomes Following Percutaneous Fixation of Proximal Humeral Fractures

Harrison

Gruson

Zmistowski

et al. 2012

The Journal of Bone & Joint Surgery

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“…In this subset of individuals surgical treatment is recommended [5]. The widely accepted treatment of severely comminuted intra-articular proximal humeral fractures is hemi-arthroplasty or total shoulder arthroplasty [6,7]. Several surgical treatment options, such as closed reduction and percutaneous fixation [8], open reduction and internal fixation with a variety of constructs [9][10][11][12][13], proximal humeral intra medullary nailing [14] and shoulder arthroplasty [15], have been used with relatively good outcomes.…”

Section: Introductionmentioning

confidence: 99%

Complex Proximal Humeral Fractures (Three or Four Part) with Dislocation: Outcome Analysis of Percutaneous Reduction and External Fixation

Nikose¹

2016

MOJOR

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Background: The complex fractures of the proximal humerus remain dilemmas far as treatment is concerned. Although better-quality techniques of internal fixation and prosthetic replacement are introduced effectively in the field of operative fracture care, management of complex fractures of the proximal humerus for head preserving modalities in injuries involving the humeral head remains to be a major factor concerning the trauma surgeon. Materials & Methods:Thirty nine patients with complex three or four part proximal fracture of humerus with dislocation of humeral head were treated and analyzed for results of percutaneous reduction and external fixation. All Patients were subjected to careful closed reduction under general anesthesia with optimal relaxation and fluoroscopic control followed by percutaneous external fixation of proximal humerus in optimal position. The patients were evaluated clinically and radiologically for a period till union or 10 months, whichever was earlier.One patient had an incomplete brachial plexus injury, which was yet to recover completely at the end of last follow up 10 months, with acceptable hand, elbow and shoulder function.Results: Percutaneous reduction & external fixation to treat complex fractures of the proximal humerus produces good results, if correct re-position and biological principles are respected. Most of the patients were pain-free and the shoulders functioned well despite the severity of shoulder injury. Conclusions:Percutaneous reduction and external fixation is a reasonable and logical approach to treat complex proximal humeral head fractures, rather than conservative treatment and before hemi-arthroplasty by prosthesis is considered, in view of the acceptable results obtained. Our study shows that complex fractures of the proximal humerus should be treated initially by head preserving procedures. The probable revascularization of the humeral head occurs by creeping substitution as the shoulder is non weight bearing joint.

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Outcome after primary hemiarthroplasty for fracture of the head of the humerus

Cited by 310 publications

References 13 publications

Trabecular metal™ shoulder prosthesis in the treatment of complex proximal humeral fractures

Trabecular metal™ shoulder prosthesis in the treatment of complex proximal humeral fractures

Intermediate Outcomes Following Percutaneous Fixation of Proximal Humeral Fractures

Complex Proximal Humeral Fractures (Three or Four Part) with Dislocation: Outcome Analysis of Percutaneous Reduction and External Fixation

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