[Complex proximal humerus fractures--management with a humeral head prosthesis? Clinical and radiological results of a prospective study]
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1Abteilung für Unfall- und Wiederherstellungschirurgie, Klinik und Poliklinik für Chirurgie, Universität, Schillingallee 35, 18055 Rostock. philip.gierer@med.uni-rostock.de
Background:
Proximal humerus fractures are one of the most common fractures in elderly patients. In the treatment of complex proximal humerus fractures, primary hemiarthroplasty is still discussed controversially. The present study was undertaken to evaluate the results of primary hemiarthroplasty in the treatment of proximal humerus fractures with a modular prosthesis (EPOCA, Fa. Argomedical, Gifhorn, Germany).
Material And Methods:
A prospective study of 24 patients with complex humerus fracture (NEER: IV/4, V/4, VI/4, and head split fracture) was performed from August 2000 to December 2002. Mean age was 75.6 years (range: 52-92); 18 patients were seen for follow-up after 0.5 and 1 year, respectively. The Constant-Murley score (max. 100 points) and the UCLA Rating System (max. 35 points) were calculated for functional assessment of the operated shoulder.
Results:
Fifteen patients (83%) were pain free 1 year after the operation. The Constant-Murley score improved from 52 (+/-17) to 56 (+/-18) at the second follow-up after 1 year. On the contralateral side a score of 86 (+/-10) was assessed (p<0.05 vs operated side). Correspondingly, shoulder function according to the UCLA Rating System improved [25 (+/-4); 27 (+/-5)].
Conclusions:
Osteoporotic bone of older patients often may not permit stable internal fixation of complex proximal humerus fractures. In these situations primary hemiarthroplasty is the treatment of choice.
