TREATMENT OF COMPLEX FRACTURES OF THE HUMERUS USING HEMIARTHROPLASTY

Abstract

Introduction and Objectives: The treatment of complex fractures of the humerus continues to be a challenge. The purpose of this study is to evaluate the results of hemiarthroplasty in the treatment of these kinds of fractures.

Materials and Methods: This is a retrospective analysis of 22 cases of fractures treated with hemiarthroplasty between 1998 and 2002 with a minimum follow-up time of one year. Neer’s classification was used. All fractures were in 3 or 4 fragments or were fracture/dislocations. Epidemiological, surgical, and rehabilitative data were recorded. Results were analyzed using Constant’s test and American Shoulder and Elbow Surgeon (ASES) criteria, which evaluate pain, mobility, strength, stability, and daily activities.

Results: Patients were predominantly female (63.6%), with an average age of 69.5 years, and the right side was affected in 54.5% of cases. Average Constant score was 49.2 points, with the primary problem being lack of strength. In 90.9% of patients, there was no pain or only slight pain on the ASES scale. Average active elevation was 92.8° with anteropulsion of 60°–90° in 45.5% and 90°–120° in 45.5% of patients. Average external rotation with the arm at 90° was 15°, and average passive internal rotation was 54.1%. There were 81.8% of patients that were able to raise their hand to the level of L5 or higher. In more than 85% of cases, patients were able to maintain perineal care, put a hand in a back pocket, use silverware, or dress themselves with little or no difficulty. Combing hair, sports, throwing, and raising objects presented the greatest problems.

Discussion and Conclusions: As in most other studies, results were modest in terms of mobility and strength, but in view of the great improvement in pain and the fact that the majority of patients regained the ability to engage in daily activities, we believe that this treatment is useful for complex fractures of the humerus.