Replacement of humeral head prosthesis for older fractures of proximal humerus / 中华骨科杂志

ABSTRACT

Objective To evaluate the results and relating factors in the treatment of proximal humeral fractures by replacement of humeral head prosthesis. Methods From March 2000 to March 2003, 21 cases with proximal humeral fractures, which were 10 males and 11 females aging from 62 to 82 years with an average of 72.3 years, were admitted to our hospital. All the patients were underwent one-stage operation of humeral head hemiarthroplasty through the anteromedial approach of shoulder joint. The average operative time was 60 minutes (range, 40 to 80 minutes) with a blood loss ranging form 200 ml to 300 ml. According to Neer classification, 6 cases were three-part fractures, 13 four-part fractures, and 2 head-splitting fractures. There were 18 fresh fractures and 3 old fractures. All the fractures were treated with replacement of humeral head prosthesis. After operation, the upper extremity was immobilized for 6 weeks, however, physical therapy, including pendulum, isometric elbow, and wrist and hand exercises, was begun on the first day after surgery. Results The follow-up ranged from 6 to 36 months with a mean period of 14.6 months. No lessening prosthesis, prosthesis dislocation, postoperative infection, nerve damage or periprosthesis fractures occurred. According to the scoring system modification for hemiarthroplasty (SSMH) of UCLA (Los. Angeles, California, USA) based on shoulder pain, functional status, muscle strength and range of motion, the average score was 24.5. Furthermore, the score was above 27 (excellent) in 3 cases, and 24 to 27 (good) in 14, and the excellent rate was 86%. The average score of pain was 9.3, function 8.6, muscle strength 8.2 in 21 cases. Conclusion Replacement of humeral head prosthesis is a preferable method for the treatment of proximal humeral fractures in the elderly patients, with significant effects in keeping the function and relieving the pain of the shoulder joint postoperatively.