Hemiarthroplasty for proximal humerus fractures with conservation of the whole humeral head as autograft: does it improve greater tuberosity healing?
Hemiarthroplasty (HA) for proximal humerus fracture (PHF) is associated with tuberosity complications like migration, non-union, and resorption. In order to improve the rate of consolidation of the greater tuberosity (GT), we have developed a hollow humeral head prosthesis in which the whole humeral head is inserted and used as autograft. This study is designed to evaluate the consolidation rate of the GT with this device.
Twenty-two patients at mean age of 68 were treated between 2015 and 2017 for four-part fractures, fracture-dislocations, and head-split fractures with HA including the bony humeral head. The humeral prosthesis device comprises a prosthetic cephalic cup in which the detached humeral head is inserted and a cementless adjustable humeral stem which works like a jack. Mean follow-up was 14 months. The consolidation of GT was followed on X-rays. As comparison, 15 published series were selected and analyzed.
There were two mechanical complications related to GT consolidation (9.1%). In the 20 other cases, the GT was radiologically consolidated without displacement. While the raw proportion of complications observed in the present series was lower than that reported in each of the 15 comparative series, the proportion of complications observed in the present series was significantly different from that observed only in seven out of the 15 previous series.
Whole conservation of the humeral head as an autograft along with proper surgical technique yielded in 20 consolidations of GT without displacement in 22 cases of PHF treated with hemiarthroplasty.
KeywordsHumeral autograft Proximal humerus fracture Shoulder hemiarthroplasty Tuberosity
Compliance with ethical standards
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
- 2.Antuna SA, Sperling JW, Cofield RH. (2008) Shoulder hemiarthroplasty for acute fractures of the proximal humerus: a minimum five-year follow-up. J Shoulder Elbow Surg 17:202–209. https://doi.org/10.1016/j.jse.2007.06.025
- 8.Gronhagen CM, Abbaszadegan H, Revay SA, Adolphson PY (2007) Medium-term results after primary hemiarthroplasty for comminute proximal humerus fractures: a study of 46 patients followed up for an average of 4.4 years. J Shoulder Elbow Surg 16:766–773. https://doi.org/10.1016/j.jse.2007.03.017 CrossRefPubMedGoogle Scholar
- 9.Loew M, Heitkemper S, Parsch D, Schneider S, Rickert M (2006) Influence of the design of the prosthesis on the outcome after hemiarthroplasty of the shoulder in displaced fractures of the head of the humerus. J Bone Joint Surg Br 88:345–350. https://doi.org/10.1302/0301-620X.88B3.16909 CrossRefPubMedGoogle Scholar
- 10.Kralinger F, Schwaiger R, Wambacher M, Farrell E, Menth-Chiari W, Lajtai G et al (2004) Outcome after primary hemiarthroplasty for fracture of the head of the humerus. A retrospective multicentre study of 167 patients. J Bone Joint Surg Br 86:217–219. https://doi.org/10.1302/0301-620X.86B2.14553 CrossRefPubMedGoogle Scholar
- 11.Mighell MA, Kolm GP, Collinge CA, Frankle MA. (2003) Outcomes of hemiarthroplasty for fractures of the proximal humerus. J Shoulder Elb Surg 12:569–577. https://doi.org/10.1016/S1058-2746(03) 00213-1
- 15.White JJ, Soothill JR, Morgan M, DI2 C, Espag MP, Tambe AA (2017) Outcomes for a large metaphyseal volume hemiarthroplasty in complex fractures of the proximal humerus. J Shoulder Elb Surg 26(3):478–483. https://doi.org/10.1016/j.jse.2016.08.004
- 16.Lopiz Y, García-Coiradas J, Serrano-Mateo L, García-Fernández C, Marco F (2016) Reverse shoulder arthroplasty for acute proximal humeral fractures in the geriatric patient: results, health-related quality of life and complication rates. Int Orthop 40(4):771–781. https://doi.org/10.1007/s00264-015-3085-z CrossRefPubMedGoogle Scholar
- 25.Boons HW1, Goosen JH, van Grinsven S, van Susante JL, van Loon CJ (2012) Hemiarthroplasty for humeral four-part fractures for patients 65 years and older: a randomized controlled trial. Clin Orthop Relat Res 470(12):3483–3491. https://doi.org/10.1007/s11999-012-2531-0 CrossRefPubMedPubMedCentralGoogle Scholar
- 27.F1 R, Mühlhäusler B, Wahl D, Nijs S (2010) Functional outcome of shoulder hemiarthroplasty for fractures: a multicentre analysis. Injury 41(6):606–612. https://doi.org/10.1016/j.injury.2009.11.019
- 29.Agresti A, Coull BA (1998) Approximate is better than «exact» for interval estimation of binomial proportions. Am Stat 52(2):119–126Google Scholar
- 30.Deeks JJ, Higgins JPT, Altman DG (2008) Identifying and measuring heterogeneity. In Higgins JPT, Green S (eds) Cochrane handbook for systematic reviews of interventions, John Wiley & Sons Ltd, Chichester UK, pp 277–278Google Scholar
- 32.Schwarzer G (2007) Meta: an R package for meta-analysis. R News 7(3):40–45Google Scholar
- 38.Van Wunnik BPW, Weijers PHE, Van Helden SH, Brink PRG, Poeze M, M (2011) Osteoporosis is not a risk factor for the development of nonunion: a cohort nested case–control study. Injury 42(12):1491–1494. https://doi.org/10.1016/j.injury.2011.08.019