Hemiarthroplasty for proximal humerus fractures

Abstract

Proximal humerus fractures are common injuries that are increasing in incidence with the increasing life expectancy and associated rise in osteoporosis. Majority of the proximal humerus fractures are minimally displaced and can be treated non-operatively with good functional results. However unstable displaced fractures have high morbidity especially in older patients. These unstable and displaced fractures may require operative intervention to ensure a successful outcome. Evaluation of both patient and fracture characteristics is important in deciding the appropriate type of surgical intervention. The aim of surgical fixation is to restore articular congruency, alignment and the proper positioning of tuberosities with respective to humeral head. Hemiarthroplasty is indicated in fracture dislocations, head splitting fractures and some three or four part fractures. In the elderly, especially with more complex four-part fractures and fracture dislocations, hemiarthroplasty and reverse total shoulder arthroplasty are indicated to decrease complication rates and improve functional outcomes. Restoration of proper humeral height, version and tuberosity position are key to success in hemiarthroplasty. Fractures in which the tuberosities are unlikely to unite or cannot be reconstructed well, reverse total shoulder arthroplasty should be considered.