Study of Functional Outcome of Three or Four Part Proximal Humerus Fracture Treated with Primary Hemiarthroplasty

Abstract

Introduction: The treatment of displaced proximal humerus fracture is challenging and at the same time controversial. It varies from conservative to surgical management. Primary hemiarthroplasty in proximal humerus fracture is indicated in three or four part fracture or fracture dislocations. Main aims of treatment in open reduction and internal fixation are preservation of vascularity of humeral head and an anatomical reduction of fracture, which is difficult in three or four part fractures of proximal humerus. Hence we studied functional outcome of 3 or 4 part proximal humerus fracture treated with primary hemiarthroplasty. Materials and Methods: Fifteen patients diagnosed with three or four part proximal humerus fracture underwent primary hemiarthroplasty between January 2017 and June 2018. Functional evaluation based on constant score and radiological assessments by periodic X-rays were done. All patients were operated in a ‘beach chair position’. The lesser and greater tuberosity were dissected with their tendinous attachments and were later reattached to the proximal humerus for stability of the prosthesis. Results: Mean follow up was 14.3 months (range 11-18 months). Mean age was 61.20 years (range 48–78 years). Ten patients were male and five were female. Mean Constant score was 55.25 (range 43.2-64.4) points at final follow up. . Mean anterior elevation was 119.5°(range 750-1500). Mean active abduction was 104° (range 57° - 130°). Mean external rotation was 24° (range 16º - 30º). Proximal migration of tuberosity was present in two patients. Two patients had moderate pain at their final follow up. Twelve (i.e., 80%) patients were satisfied about their functional outcome. Conclusion: The study showed hemiarthroplasty is a better option in treating proximal humerus fracture in elderly but also is a viable alternative to osteosynthesis for grossly comminuted proximal humerus fractures in young adults.