[Primary hemiarthroplasty in proximal humerus fractures]

The surgical treatment of complex proximal humerus fractures is still a great challenge. Not all fracture types can be successfully reconstructed. Indications for a primary joint replacement arise from critical fracture patterns and defined predictors of ischemia in the elderly (age >60 years). If good functional results are to be achieved a soft-tissue-preserving surgical technique, secure tuberosity attachment and accurate soft tissue balancing of the rotator cuff, correct restoration of height, retrotorsion and offset, and appropriate physiotherapy afterwards are essential. In multicentre studies in patients who had undergone primary hemoarthroplasty average Constant-Murlay Scores of 56.0-73.5 point were recorded. At follow-up, 79% of the patients reported only mild pain or none at all, and the ROM was acceptable (41.9% anteversion >90 degrees , 34.7% abduction >90 degrees ). Generally, subjective evaluations were much better than the objective results.The incidence of complications after humeral head replacement is still relatively high, whereas the 10-year survival rate of shoulder hemiarthroplasties has been found in a recent study to be 100%.