2022, Number 6
<< Back Next >>
Acta Ortop Mex 2022; 36 (6)
Functional results after shoulder hemiarthroplasty for proximal humerus fracture: experience in our center
Suárez-Quintero A, Fernández-Domínguez J, López-Sorroche E
Language: Spanish
References: 40
Page: 359-366
PDF size: 213.12 Kb.
ABSTRACT
Introduction: shoulder hemiarthroplasty is being relegated as a treatment for non-osteosynthetic proximal humerus fractures. Our objective is to analyze the functional results of patients treated with hemiarthroplasty for this reason in our hospital.
Material and methods: cross-sectional descriptive study that includes patients operated between February 2016 and November 2021; 24 patients, with an average follow-up of 44.6 months. Active joint balance, the Constant-Murley test, the DASH questionnaire and current pain (VAS) were collected. The radiographic parameters analyzed were the number of fracture fragments and the consolidation of the tuberosities.
Results: a mean of 71.65 ± 13.75 was obtained in the Constant-Murley and 18.14% ± 13.92 in the DASH. For shoulder flexion, the mean was 108.75° ± 41.26; 104.5° ± 43.68 for abduction and 33° ± 14.73 for external rotation. About internal rotation, 60% of the patients reached the scapular plane. Average VAS was 1.25 ± 1.74. Consolidated tuberosities in 90.5%. There were no significant differences comparing the Constant-Murley test, DASH or rotations between both, over and under 65 years old group of patients. Those over 65 years of age obtained a mean flexion of 125.91° ± 26.82 whereas those under 87.78° ± 26.82 (p = 0.038). The mean abduction in those over 65 was 125.45 ± 28.94 vs 78.89 ± 46.29 in the young group (p = 0.012).
Conclusion: hemiarthroplasty provides quality of life with acceptable functionality and good pain control, therefore it should continue to be an alternative to consider in selected patients.
REFERENCES
Shukla DR, McAnany S, Kim J, Overley S, Parsons BO. Hemiarthroplasty versus reverse shoulder arthroplasty for treatment of proximal humeral fractures: a meta-analysis. J Shoulder Elbow Surg. 2016; 25(2): 330-40. doi: 10.1016/j.jse.2015.08.030.
Estrada-Malacón CA, Torres-Zavala A, Navarro-González BE, Fonseca-Bemal M. Resultados funcionales de fracturas Neer III-IV tratadas mediante hemiartroplastía. Acta Ortop Mex. 2014; 28(4): 224-7.
Giovale M, Mangano T, Rodá E, Repetto I, Cerruti P, Kuqi E, et al. Shoulder hemiarthroplasty for complex humeral fractures: a 5 to 10-year follow-up retrospective study. Musculoskelet Surg. 2014; 98 Suppl 1: 27-33.
Kontakis GM, Tosounidis TI, Christoforakis Z, Hadjipavlou AG. Early management of complex proximal humeral fractures using the Aequalis fracture prosthesis: a two- to five-year follow-up report. J Bone Joint Surg Br. 2009; 91(10): 1335-40. doi: 10.1302/0301-620X.91B10.22473.
Sebastiá-Forcada E, Cebrián-Gómez R, Lizaur-Utrilla A, Gil-Guillén V. Reverse shoulder arthroplasty versus hemiarthroplasty for acute proximal humeral fractures. A blinded, randomized, controlled, prospective study. J Shoulder Elbow Surg. 2014; 23(10): 1419-26. doi: 10.1016/j.jse.2014.06.035.
Valenti P, Aliani D, Maroun C, Werthel JD, Elkolti K. Shoulder hemiarthroplasty for proximal humeral fractures: analysis of clinical and radiographic outcomes at midterm follow-up: a series of 51 patients. Eur J Orthop Surg Traumatol. 2017; 27(3): 309-15. doi: 10.1007/s00590-017-1927-7.
Olerud P, Ahrengart L, Ponzer S, Saving J, Tidermark J. Hemiarthroplasty versus nonoperative treatment of displaced 4-part proximal humeral fractures in elderly patients: a randomized controlled trial. J Shoulder Elbow Surg. 2011; 20(7): 1025-33. doi: 10.1016/j.jse.2011.04.016.
Namdari S, Horneff JG, Baldwin K. Comparison of hemiarthroplasty and reverse arthroplasty for treatment of proximal humeral fractures: a systematic review. J Bone Joint Surg Am. 2013; 95(18): 1701-8. doi: 10.2106/JBJS.L.01115.
Klug A, Gramlich Y, Wincheringer D, Schmidt-Horlohé K, Hoffmann R. Trends in surgical management of proximal humeral fractures in adults: a nationwide study of records in Germany from 2007 to 2016. Arch Orthop Trauma Surg. 2019; 139(12): 1713-21. doi: 10.1007/s00402-019-03252-1.
Hashiguchi H, Iwashita S, Ohkubo A, Takai S. The outcome of hemiarthroplasty for proximal humeral fractures is dependent on the status of the rotator cuff. Int Orthop. 2015; 39(6): 1115-9. doi: 10.1007/s00264-015-2758-y.
Hawkins RJ. Displaced proximal humeral fractures. Orthopedics. 1993; 16(1): 49-53. doi: 10.3928/0147-7447-19930101-09.
Martínez Sola R, Ruiz Rico Gómez J, Santonja Medina F, Martínez Martínez F. El test de Constant-Murley como método de valoración clínica para el seguimiento de las fracturas de extremidad proximal del humero: revisión y controversias. Rev Soc Andal Traumatol Ortop. 2020; 37(2/4): 8-16.
Hervás MT, Navarro Collado MJ, Peiró S, Rodrigo Pérez JL, López Matéu P, Martínez Tello I. Versión española del cuestionario DASH. Adaptación transcultural, fiabilidad, validez y sensibilidad a los cambios. Med Clin (Barc). 2006; 127(12): 441-7. doi: 10.1157/13093053.
Demirhan M, Kilicoglu O, Altinel L, Eralp L, Akalin Y. Prognostic factors in prosthetic replacement for acute proximal humerus fractures. J Orthop Trauma. 2003; 17(3): 181-8; discussion 188-9. doi: 10.1097/00005131-200303000-00004.
Levy J, Frankle M, Mighell M, Pupello D. The use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty for proximal humeral fracture. J Bone Joint Surg Am. 2007; 89(2): 292-300. doi: 10.2106/JBJS.E.01310.
Davey MS, Hurley ET, Anil U, Condren S, Kearney J, O'Tuile C, et al. Management options for proximal humerus fractures - A systematic review & network meta-analysis of randomized control trials. Injury. 2022; 53(2): 244-9. doi: 10.1016/j.injury.2021.12.022.
Gallinet D, Clappaz P, Garbuio P, Tropet Y, Obert L. Three or four parts complex proximal humerus fractures: hemiarthroplasty versus reverse prosthesis: a comparative study of 40 cases. Orthop Traumatol Surg Res. 2009; 95(1): 48-55. doi: 10.1016/j.otsr.2008.09.002.
Loew M, Heitkemper S, Parsch D, Schneider S, Rickert M. Influence of the design of the prosthesis on the outcome after hemiarthroplasty of the shoulder in displaced fractures of the head of the humerus. J Bone Joint Surg Br. 2006; 88(3): 345-50. doi: 10.1302/0301-620X.88B3.16909.
Wild JR, DeMers A, French R, Shipps MR, Bergin PF, Musapatika D, et al. Functional outcomes for surgically treated 3- and 4-part proximal humerus fractures. Orthopedics. 2011; 34(10): e629-33. doi: 10.3928/01477447-20110826-14. Erratum in: Orthopedics. 2012; 35(1): 27.
Noyes MP, Kleinhenz B, Markert RJ, Crosby LA. Functional and radiographic long-term outcomes of hemiarthroplasty for proximal humeral fractures. J Shoulder Elbow Surg. 2011; 20(3): 372-7. doi: 10.1016/j.jse.2010.06.009.
Thorsness R, Iannuzzi J, Noyes K, Kates S, Voloshin I. Open reduction and internal fixation versus hemiarthroplasty in the management of proximal humerus fractures. Geriatr Orthop Surg Rehabil. 2014; 5(2): 56-62. doi: 10.1177/2151458514527292.
Baudi P, Campochiaro G, Serafini F, Gazzotti G, Matino G, Rovesta C, et al. Hemiarthroplasty versus reverse shoulder arthroplasty: comparative study of functional and radiological outcomes in the treatment of acute proximal humerus fracture. Musculoskelet Surg. 2014; 98 Suppl 1: 19-25. doi: 10.1007/s12306-014-0322-3.
Bonnevialle N, Tournier C, Clavert P, Ohl X, Sirveaux F, Saragaglia D. Hemiarthroplasty versus reverse shoulder arthroplasty in 4-part displaced fractures of the proximal humerus: multicenter retrospective study. Orthop Traumatol Surg Res. 2016; 102(5): 569-73. doi: 10.1016/j.otsr.2016.02.014.
Gronhagen CM, Abbaszadegan H, Révay SA, Adolphson PY. Medium-term results after primary hemiarthroplasty for comminute proximal humerus fractures: a study of 46 patients followed up for an average of 4.4 years. J Shoulder Elbow Surg. 2007; 16(6): 766-73. doi: 10.1016/j.jse.2007.03.017.
Spross C, Platz A, Erschbamer M, Lattmann T, Dietrich M. Surgical treatment of Neer group VI proximal humeral fractures: retrospective comparison of PHILOS® and hemiarthroplasty. Clin Orthop Relat Res. 2012; 470(7): 2035-42. doi: 10.1007/s11999-011-2207-1.
Esen E, Dogramaci Y, Gültekin S, Deveci MA, Suluova F, Kanatli U, et al. Factors affecting results of patients with humeral proximal end fractures undergoing primary hemiarthroplasty: a retrospective study in 42 patients. Injury. 2009; 40(12): 1336-41. doi: 10.1016/j.injury.2009.06.019.
Pijls BG, Werner PH, Eggen PJ. Primary uncemented hemiarthroplasty for severe fractures of the proximal humerus. J Orthop Trauma. 2011; 25(5): 279-85. doi: 10.1097/BOT.0b013e3181eaa648.
Boyer E, Menu G, Loisel F, Saadnia R, Uhring J, Adam A, et al. Cementless and locked prosthesis for the treatment of 3-part and 4-part proximal humerus fractures: prospective clinical evaluation of hemi- and reverse arthroplasty. Eur J Orthop Surg Traumatol. 2017; 27(3): 301-8. doi: 10.1007/s00590-017-1926-8.
Cai M, Tao K, Yang C, Li S. Internal fixation versus shoulder hemiarthroplasty for displaced 4-part proximal humeral fractures in elderly patients. Orthopedics. 2012; 35(9): e1340-6. doi: 10.3928/01477447-20120822-19.
Prakash U, McGurty DW, Dent JA. Hemiarthroplasty for severe fractures of the proximal humerus. J Shoulder Elbow Surg. 2002; 11(5): 428-30. doi: 10.1067/mse.2002.126615.
Boons HW, Goosen JH, van Grinsven S, van Susante JL, van Loon CJ. Hemiarthroplasty for humeral four-part fractures for patients 65 years and older: a randomized controlled trial. Clin Orthop Relat Res. 2012; 470(12): 3483-91.
Garrigues GE, Johnston PS, Pepe MD, Tucker BS, Ramsey ML, Austin LS. Hemiarthroplasty versus reverse total shoulder arthroplasty for acute proximal humerus fractures in elderly patients. Orthopedics. 2012; 35(5): e703-8. doi: 10.3928/01477447-20120426-25.
Cuff DJ, Pupello DR. Comparison of hemiarthroplasty and reverse shoulder arthroplasty for the treatment of proximal humeral fractures in elderly patients. J Bone Joint Surg Am. 2013; 95(22): 2050-5. doi: 10.2106/JBJS.L.01637.
Antuña SA, Sperling JW, Cofield RH. Shoulder hemiarthroplasty for acute fractures of the proximal humerus: a minimum five-year follow-up. J Shoulder Elbow Surg. 2008; 17(2): 202-9. doi: 10.1016/j.jse.2007.06.025.
Chalmers PN, Slikker W 3rd, Mall NA, Gupta AK, Rahman Z, Enriquez D, et al. Reverse total shoulder arthroplasty for acute proximal humeral fracture: comparison to open reduction-internal fixation and hemiarthroplasty. J Shoulder Elbow Surg. 2014; 23(2): 197-204. doi: 10.1016/j.jse.2013.07.044.
Young SW, Segal BS, Turner PC, Poon PC. Comparison of functional outcomes of reverse shoulder arthroplasty versus hemiarthroplasty in the primary treatment of acute proximal humerus fracture. ANZ J Surg. 2010; 80(11): 789-93. doi: 10.1111/j.1445-2197.2010.05342.x.
Boileau P, Walch G, Krishnan SG. Tuberosity osteosynthesis and hemiarthroplasty for four-part fractures of the proximal humerus. Tech Shoulder Elb Surg. 2000; 1: 96-109.
Boileau P, Krishnan SG, Tinsi L, Walch G, Coste JS, Molé D. Tuberosity malposition and migration: reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus. J Shoulder Elbow Surg. 2002; 11(5): 401-12. doi: 10.1067/mse.2002.124527.
Huffman GR, Itamura JM, McGarry MH, Duong L, Gililland J, Tibone JE, et al. Neer Award 2006: Biomechanical assessment of inferior tuberosity placement during hemiarthroplasty for four-part proximal humeral fractures. J Shoulder Elbow Surg. 2008; 17(2): 189-96.
Foruria AM, de Gracia MM, Larson DR, Munuera L, Sanchez-Sotelo J. The pattern of the fracture and displacement of the fragments predict the outcome in proximal humeral fractures. J Bone Joint Surg Br. 2011; 93(3): 378-86. doi: 10.1302/0301-620X.93B3.25083.
EVIDENCE LEVEL
IV