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Hemiarthroplasty for Humeral Four-part Fractures for Patients 65 Years and Older: A Randomized Controlled Trial

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Four-part fractures of the proximal humerus account for 3% of all humeral fractures and are regarded as the most difficult fractures to treat in the elderly. Various authors recommend nonoperative treatment or hemiarthroplasty, but the literature is unclear regarding which provides better quality of life and function.

Questions/purposes

We therefore performed a randomized controlled trial to compare (1) function, (2) strength, and (3) pain and disability in patients 65 years and older with four-part humeral fractures treated either nonoperatively or with hemiarthroplasty.

Methods

We randomly allocated 50 patients to one of the two approaches. There were no differences in patient demographics between the two groups. The Constant-Murley score was the primary outcome measure. Secondary outcome measures were the Simple Shoulder Test, abduction strength test as measured by a myometer, and VAS scores for pain and disability. All patients were assessed at 12 months.

Results

We found no between-group differences in Constant-Murley and Simple Shoulder Test scores at 3- and 12-months followup. Abduction strength was better at 3 and 12 months in the nonoperatively treated group although the nonoperatively treated patients experienced more pain at 3 months; this difference could not be detected after 12 months.

Conclusions

We observed no clear benefits in treating patients 65 years or older with four-part fractures of the proximal humerus with either hemiarthroplasty or nonoperative treatment.

Level of Evidence

Level I, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Geert-Jan Boog MD (GJB), orthopaedic surgeon, for the inclusion of patients, and as operating consultant in this trial. Dr. Boog died in 2009.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Elkerliek Hospital, Helmond, The Netherlands

    Harm W. Boons MD

  2. Department of Orthopaedics, Rijnstate Hospital, PO Box 9555, 6800 TA, Arnhem, The Netherlands

    Jon H. Goosen MD, PhD, Susan van Grinsven MSc, Job L. van Susante MD, PhD & Corné J. van Loon MD, PhD

Authors
  1. Harm W. Boons MD
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  2. Jon H. Goosen MD, PhD
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  3. Susan van Grinsven MSc
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  4. Job L. van Susante MD, PhD
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  5. Corné J. van Loon MD, PhD
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Corresponding author

Correspondence to Corné J. van Loon MD, PhD.

Additional information

The institution of one or more of the authors (JHG, SvG, JvS, CJvL) has received funding (St Elisabeth Research Foundation) from DePuy Orthopaedics, Inc, a Johnson & Johnson company (Warsaw, IN, USA). Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at the Rijnstate Hospital, Arnhem, The Netherlands.

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Boons, H.W., Goosen, J.H., van Grinsven, S. et al. Hemiarthroplasty for Humeral Four-part Fractures for Patients 65 Years and Older: A Randomized Controlled Trial. Clin Orthop Relat Res 470, 3483–3491 (2012). https://doi.org/10.1007/s11999-012-2531-0

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  • DOI: https://doi.org/10.1007/s11999-012-2531-0

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