[Primary hemiarthroplasty in proximal humerus fractures]

Area of Science:

• Orthopedic Surgery
• Traumatology
• Biomedical Engineering

Background:

• Complex proximal humerus fractures present significant surgical challenges, with not all types amenable to successful reconstruction.
• Indications for primary joint replacement in these fractures are linked to critical patterns and ischemia predictors in elderly patients (>60 years).

Purpose of the Study:

• To evaluate the efficacy and outcomes of primary shoulder hemiarthroplasty for complex proximal humerus fractures in elderly patients.
• To identify key factors for achieving good functional results and assess complication rates and long-term survival.

Main Methods:

• Review of multicenter studies involving primary shoulder hemiarthroplasty for complex proximal humerus fractures.
• Analysis of functional outcomes using Constant-Murley Scores, range of motion (ROM), pain levels, and subjective patient evaluations.
• Assessment of complication incidence and 10-year survival rates of shoulder hemiarthroplasties.

Main Results:

• Average Constant-Murley Scores ranged from 56.0-73.5 in multicenter studies.
• At follow-up, 79% of patients reported minimal to no pain, with acceptable ROM (41.9% anteversion >90°, 34.7% abduction >90°).
• Subjective patient outcomes generally surpassed objective results, though complication rates remain relatively high.

Conclusions:

• Shoulder hemiarthroplasty is a viable option for specific complex proximal humerus fractures in the elderly, particularly when reconstruction is not feasible.
• Achieving optimal results necessitates a soft-tissue-preserving technique, secure tuberosity fixation, accurate rotator cuff balancing, and proper anatomical restoration.
• While complications are common, shoulder hemiarthroplasty demonstrates a high 10-year survival rate, indicating long-term implant durability.