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Humeral head replacement for acute, four-part proximal humerus fractures
A Green1, W L Barnard, R S Limbird
1Department of Orthopaedic Surgery, Rhode Island Hospital, USA; Brown University School of Medicine, Providence, R.I.
Journal of Shoulder and Elbow Surgery
|September 11, 2012
Summary
Humeral head replacement effectively manages acute proximal humerus fractures, preventing pain in most patients. Functional outcomes vary, influenced by age and individual needs.
Area of Science:
- Orthopedic Surgery
- Traumatology
- Reconstructive Surgery
Background:
- Four-part proximal humerus fractures and fracture dislocations are complex injuries.
- Humeral head replacement is a treatment option for these severe fractures.
Purpose of the Study:
- To evaluate the outcomes of humeral head replacement in acute, four-part proximal humerus fractures and fracture dislocations.
- To assess pain levels, range of motion, functional outcomes, and patient satisfaction.
Main Methods:
- Twenty-eight patients with acute, four-part proximal humerus fractures/dislocations underwent humeral head replacement.
- Twenty-four patients were evaluated at an average follow-up of 37 months using American Shoulder and Elbow Surgeons criteria.
- Pain, active/passive range of motion, and functional capacity were assessed.
Main Results:
- No infections were reported; one patient required surgery for joint contracture.
- 90% of patients experienced no or only occasional slight pain.
- Average active forward elevation was 110°, with better outcomes in patients younger than 60.
- Functional outcomes were variable, with about half achieving activities at or above shoulder level.
Conclusions:
- Humeral head replacement reliably prevents shoulder pain in acute, four-part proximal humerus fractures.
- Functional outcomes are variable and depend on patient age, functional demands, and rotator cuff integrity.
- Most patients (89%) reported satisfaction with the treatment.
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