Abstract
Objective: In the constantly growing population of people beyond the age of 60 years, the incidence of complex comminuted humeral head fractures increases, thus increasing the need for prosthetic replacement. The purpose of this study was to determine the long-term results after primary hemiarthroplasty in patients older than 60 years. Methods: From 08/2010 to 12/2015 a prospective study of 54 patients (mean age 75 years) with complex humeral head fracture was performed at the University Hospital Rostock. 24 patients were available for follow-up after 5 - 10 years. Pain, the Karnofsky-index, and the range of motion were obtained as well as radiographs in two planes. The Constant-Murley score and the UCLA rating system were evaluated for functional assessment. Results: 15 patients were painfree. The Karnofsky index deteriorated from 94 preoperatively to 70. The Constant-Murley score of the operated extremity reached 47 points out of possible 100, the uninjured side scored 82 points. The age-specific Constant-Murley score showed more favorable results. The UCLA rating system values leveled up to 22 out of 35 points for the replaced shoulder and 33 points for the other arm. Radiologically, more than 50% of the implants were classified as non-centered and the acromio-humeral space diminished significantly. Conclusions: Primary hemiarthroplasty helps to restore a situation of little or no pain whereas functional and radiological outcome remains limited. Revision surgery or conversion to reverse shoulder arthroplasty was not indicated in any case supporting the clinical value of hemiarthroplasty.
Highlights
A United Nations survey estimates that by 2050, approximately 2 billion people worldwide have attained a minimum age of 60 years
From 08/2010 to 12/2015 a prospective study of 54 patients with complex humeral head fracture was performed at the University Hospital Rostock. 24 patients were available for follow-up after 5 - 10 years
Proximal humeral fractures account for 4% - 5% of all fractures in adults. 30% of these fractures occur in patients older than 60 years mostly after low-energy trauma and are clearly related to osteoporosis [4]
Summary
A United Nations survey estimates that by 2050, approximately 2 billion people worldwide have attained a minimum age of 60 years. 30% of these fractures occur in patients older than 60 years mostly after low-energy trauma and are clearly related to osteoporosis [4]. Even non-surgical treatment might represent a viable option in defined displaced fracture types of the humeral head with an acceptable clinical outcome which is not inferior to that after surgical intervention [6]. Consecutive failure of fracture fixation with cut-out of the screws and re-displacement occurs more often than in younger patients. Complications such as humerus head necrosis reduce the mid-term postoperative success and call for a change of therapeutic strategy requiring secondary prosthetic replacement [7]
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