Humeral head replacement for acute, four-part proximal humerus fractures

Twenty-eight patients with acute, four-part proximal humerus fractures and fracture dislocations were treated with humeral head replacement. At an average follow-up of 37 months (range 12 to 96 months) one author examined 24 patients and evaluated them according to the criteria of the American Shoulder and Elbow Surgeons. There were no infections. One patient had subsequent surgery for joint contracture. Nine (38%) patients had no pain, eight (33%) had occasional slight pain, three (13%) had pain with unusual activity, and four (17%) had moderate pain. No patient had marked pain or pain at rest. Average active forward elevation was 110°, average passive forward elevation was 139°, average active external rotation was 31°, and average passive internal rotation was to the L1 level. Active forward elevation of patients younger than 60 years old was significantly greater than that of older patients. Functional outcome was variable. Although most patients could perform activities below the shoulder, only about one half could perform activities at or above the shoulder level. Eighty-nine percent of patients were satisfied with their treatment. Humeral head replacement for acute, four-part fractures reliably prevented the development of shoulder pain. Functional outcome varied and was dependent on patient age, individual functional requirements, and rotator cuff integrity.