Skip to main content

Hemi-Arthroplasty for Fractures of the Proximal Humerus

  • Reference work entry
  • First Online:
European Surgical Orthopaedics and Traumatology
  • 250 Accesses

Abstract

Complex fractures of the proximal humerus are some of the most common and difficult fractures to treat. Treatment options include benign neglect, internal fixation or arthroplasty. A hemiarthroplasty for a complex proximal humeral fracture is a challenging procedure even in the experienced shoulder surgeon’s hands.

This chapter aims to explain the operative technique and tips to aid the surgeon perform the procedure safely and successfully, avoiding complications. A review of published outcomes of hemiarthroplasty for proximal humeral fractures is presented as well as possible complications and available rehabilitation protocols for the patient post-operatively.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 649.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 949.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Codman EA. Rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa. In: Codman EA, editor. The shoulder. New York: G. Miller; 1934.

    Google Scholar 

  2. Neer CS. Indications for replacement of the proximal humeral articulation. Am J Surg. 1955;89:901–7.

    Article  PubMed  Google Scholar 

  3. Neer CS, Brown TH, McLaughlin HL. Fracture of the neck of the humerus with dislocation of the head fragment. Am J Surg. 1953;85:252–8.

    Article  CAS  PubMed  Google Scholar 

  4. Neer CS. Displaced proximal humeral fractures. Part I: classification and evaluation. J Bone Joint Surg Am. 1970;52A:1077–89.

    Google Scholar 

  5. Kristiansen B, Andersen LS, Olsen CA, Vasmarken JE. The Neer classification of fractures of the proximal humerus: an assessment of interob- server variation. Skeletal Radiol. 1988;17:420–2.

    Article  CAS  PubMed  Google Scholar 

  6. Castagno AA, Shuman WP, Kilcoyno AF, Haynor OR, Moms ME, Matson FA. Complex fractures of the proximal humerus: role of CT in treatment. Radiology. 1987;165:759–62.

    CAS  PubMed  Google Scholar 

  7. Hertel R, Hempfing A, Stiehler M, Leunig M. JSES. Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. 2004;13:427–33.

    CAS  Google Scholar 

  8. Jakob RP, Miniaci A, Anson PS, Jaberg H, Osterwalder A, Ganz R. Four-part valgus impacted fractures of the proximal humerus. J Bone Joint Surg Br. 1991;73(2):295–8.

    CAS  PubMed  Google Scholar 

  9. Kontakis G, Koutras C, Tosounidis T, Giannoudis P. Early management of proximal humeral fractures with hemiarthroplasty: a systematic review. J Bone Joint Surg Br. 2008;90(11):1407–13.

    Article  CAS  PubMed  Google Scholar 

  10. Naranja Jr RJ, Iannotti JP. Displaced three- and four-part proximal humerus fractures: evaluation and management. J Am Acad Orthop Surg. 2000;8(6):373–82.

    PubMed  Google Scholar 

  11. Goldman RT, Koval KJ, Cuomo F, Gallagher MA, Zuckerman JD. Functional outcome after humeral head replacement for acute three- and four- part proximal humeral fractures. J Shoulder Elbow Surg. 1995;4(2):81–6.

    Article  CAS  PubMed  Google Scholar 

  12. Sjödén GO, Movin T, Aspelin P, Güntner P, Shalabi A. 3D-radiographic analysis does not improve the Neer and AO classifications of proximal humeral fractures. Acta Orthop Scand. 1999;70(4):325–8.

    Article  PubMed  Google Scholar 

  13. Bufquin T, Hersan A, Hubert L, Massin P. Reverse shoulder arthroplasty for the treatment of three- and four-part fractures of the proximal humerus in the elderly: a prospective review of 43 cases with a short-term follow-up. J Bone Joint Surg Br. 2007;89(4):516–20.

    Article  CAS  PubMed  Google Scholar 

  14. Gallinet D, Clappaz P, Garbuio P, Tropet Y, Obert L. Three or four parts complex proximal humerus fractures: hemiarthroplasty versus reverse prosthesis. A comparative study of 40 cases. Orthop Traumatol Surg Res. 2009;95(1):48–55.

    Article  CAS  PubMed  Google Scholar 

  15. Neer CS. Indications for replacement of the proximal humeral articulation. Am J Surg. 1955;89:901–7.

    Article  PubMed  Google Scholar 

  16. Lee CK, Hansen HR. Post-traumatic avascular necrosisof the humeral head in displaced proximal humeral fractures. J Trauma. 1981;21:788–91.

    Article  CAS  PubMed  Google Scholar 

  17. Esser RD. Treatment of three and four part fractures of the proximal humerus with a modified cloverleaf plate. J Orthop Trauma. 1994;8:15–22.

    Article  CAS  PubMed  Google Scholar 

  18. Darder A, Sanchis V, Gastaldi E, et al. Four-part displaced proximal humeral fractures: operative treatments using Kirschner wires and a tension band. J Orthop Trauma. 1993;7:497–505.

    Article  CAS  PubMed  Google Scholar 

  19. Gerber C, Hersche O, Berberat C. The clinical relevance of post traumatic a vascular necrosis of the humeral head. J Shoulder Elbow Surg. 1998;7:586–90.

    Article  CAS  PubMed  Google Scholar 

  20. Tanner MW, Cofield RH. Prosthetic arthroplasty for fractures and fracture-dislocations of the proximal humerus. Clin Orthop. 1983;179:116–28.

    Article  PubMed  Google Scholar 

  21. Norris TR, Green A, McGuigan FX. Late prosthetic shoulder arthroplasty for displaced proximal humeral fractures. J Shoulder Elbow Surg. 1995;4(4):271–80.

    Article  CAS  PubMed  Google Scholar 

  22. Zuckermann JD, Cuomo F, Coval KJ. Proximal humeral replacement for complex fractures indications and surgical technique. Instr Course Lecture. 1997;46:7–14.

    Google Scholar 

  23. Torrens C, Corrales M, Melendo E, Solano A, Rodriquez-Baeza A, Careres E. The pectoralis major tendon as a reference for restoring humeral length and retroversion with hemiarthroplasty for fracture. J Shoulder Elbow Surg. 2008;17(6):947–50.

    Article  PubMed  Google Scholar 

  24. Iannotti JP, Gabriel JP, Schneck SL, Evans BG, Misra S. The normal glenohumeral relationships. An anatomical study of one hundred and forty shoulders. J Bone Joint Surg Am. 1992;74(4):491–500.

    CAS  PubMed  Google Scholar 

  25. Hempfing A, Leunig M, Ballmer FT, Hertel R. Surgical landmarks to determine humeral head retrotorsion or hemiarthroplasty in fractures. J Shoulder Elbow Surg. 2001;10(5):460–3.

    Article  CAS  PubMed  Google Scholar 

  26. Hertel R, Knothe U, Ballmer FT. Geometry of the proximal humerus and implications for prosthetic design. J Shoulder Elbow Surg. 2002;11(4):331–8.

    Article  PubMed  Google Scholar 

  27. Boileau P, Bicknell RT, Mazzoleni N, Walch G, Urien JP. CT scan method accurately assesses humeral head retroversion. Clin Orthop Relat Res. 2008;466(3):661–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  28. Hernigou P, Duparc F, Hernigou A. Determining humeral retroversion with computed tomography. J Bone Joint Surg Am. 2002;84(10):1753–62.

    PubMed  Google Scholar 

  29. Hughes M, Neer CS. Glenohumeral joint replacement and postoperative rehabilitation. Phys Ther. 1975;55:850–8.

    CAS  PubMed  Google Scholar 

  30. Boileau P, Krishnan SG, Tinsi L, Walch G, Coste JS, Mole D. Tuberosity malposition and migration: reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus. J Shoulder Elbow Surg. 2002;11(5):401–12.

    Article  CAS  PubMed  Google Scholar 

  31. Tanner MW, Cofield RH. Prosthetic arthroplasty for fractures and fracture dislocations of the proximal humerus. Colin Orthop Relat Res. 1983;179:116–28.

    Google Scholar 

  32. Neer CS, Kirby RM. Revision of humeral head and total shoulder arthroplasties. Clin Orthop Relat Res. 1982;170:189–95.

    PubMed  Google Scholar 

  33. Majed A, Macleod I, Bull AM, Zyto K, Resch H, Hertel R, Reilly P, Emery RJ. Proximal humeral fracture classification systems revisited. J Shoulder Elbow Surg. 2011;20(7):1125–32.

    Article  PubMed  Google Scholar 

  34. Bastian JD, Hertel R. Initial post-fracture humeral head ischaemia does not predict development of necrosis. J Shoulder Elbow Surg. 2008;17(1):2–8.

    Article  PubMed  Google Scholar 

  35. Balg F, Boulianne M, Boileau P. Bicipital groove orientation: considerations for the retroversion of a prosthesis in fractures of the proximal humerus. J Shoulder Elbow Surg. 2006;15(2):195–8.

    Article  PubMed  Google Scholar 

  36. Boileau P, Krishnan SG, Tinsi L, Walch G, Coste JS, Mole D. Tuberosity malposition and migration: reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus. J Shoulder Elbow Surg. 2002;11(5):401–12.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 EFORT

About this entry

Cite this entry

Corner, T., Gikas, P.D. (2014). Hemi-Arthroplasty for Fractures of the Proximal Humerus. In: Bentley, G. (eds) European Surgical Orthopaedics and Traumatology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-34746-7_225

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-34746-7_225

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-34745-0

  • Online ISBN: 978-3-642-34746-7

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics