Skip to main content

Advertisement

SpringerLink
Log in

The long-term results of shoulder hemiarthroplasty in irreducible four-part fracture-dislocation of the proximal humerus without rotator cuff tear arthropathy

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Although there are concerns about nonunion of the greater tuberosity or shoulder weakness, hemishoulder arthroplasty (HSA) is a viable treatment option for irreducible four-part proximal humerus fractures-dislocation without rotator cuff tear arthropathy. This study aims to analyze the long-term radiological and functional outcomes of HSA.

Methods

This study enrolled 36 patients who underwent HSA due to irreducible four-part proximal humerus fracture-dislocation without rotator cuff tear arthropathy between March 2005 and May 2020. The exclusion group included 10 reverse total shoulder arthroplasty patients. The mean age and mean follow-up period were 68.6 years old and 48.6 months, respectively. Radiological assessments, such as vertical and horizontal greater tuberosity position, greater tuberosity healing, and implant position, were evaluated. Clinically, American Shoulder and Elbow Surgeons Score (ASES), Constant-Murley Score (CMS), and range of motion were evaluated.

Results

The greater tuberosity union rate was 55.6% (n = 20), with 44.4% (n = 16) experiencing nonunion, malunion, and bone resorption. The mean vertical and horizontal greater tuberosity positions showed significant difference at last follow-up compared to immediate postoperation. The retroversion of the implant was 23.8 ± 4.61°, and the acromio-humeral interval was 7.6 ± 1.34 mm. The mean last follow-up ASES and CMS were 39.5 ± 4.03 and 55.4 ± 10.41, respectively. The mean active forward flexion, abduction, internal rotation, and external rotation were 100.9 ± 15.04°, 92.5 ± 14.47°, 44.2 ± 12.83°, and 42.5 ± 15.32°, respectively.

Conclusion

In long-term follow-up, the greater tuberosity was superiorly migrated and externally rotated. Active forward flexion and abduction in the last follow-up were significantly limited. However, in terms of pain relief, a satisfactory result was seen.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Yahuaca BI, Simon P et al (2020) Acute surgical management of proximal humerus fractures: ORIF vs. hemiarthroplasty vs. reverse shoulder arthroplasty. J Shoulder Elbow Surg 29:S32–S40. https://doi.org/10.1016/j.jse.2019.10.012

    Article  PubMed  Google Scholar 

  2. Marczuk M, Plonczak M (2019) Surgical treatment outcomes of proximal humerus fractures including shoulder hemiarthroplasty in patients of the Orthopedics and Trauma Department in Siedlce. Chir Narzadow Ruchu Ortop Pol 84:101–106. https://doi.org/10.31139/chnriop.2019.84.4.20

    Article  Google Scholar 

  3. Farooq M, Bhat AA, Ringshawl Z (2019) Hemiarthroplasty for proximal humerus fractures. Int J Orthop Sci 5:1055–1063. https://doi.org/10.22271/ortho.2019.v5.i4r.1821

    Article  Google Scholar 

  4. Klute L, Pfeifer C, Weiss I, Mayr A, Alt V, Kerschbaum M (2021) Displacement of the greater tuberosity in humeral head fractures does not only depend on rotator cuff status. J Clin Med 10:4136. https://doi.org/10.3390/jcm10184136

    Article  PubMed  PubMed Central  Google Scholar 

  5. Cassart Masnou E, Ruiz Macarrilla L, Mora Sole E et al (2023) Is the position and union of the tuberosities assessable by means of the simple radiograph after reverse shoulder arthroplasty for complex proximal humerus fracture? J Shoulder Elb Arthroplast 7:1–8. https://doi.org/10.1177/24715492231152149

    Article  Google Scholar 

  6. Cheng MF, Hung SH, Su YP et al (2019) Displaced isolated greater tuberosity fractures of elder adults treated with plate osteosynthesis. J Chin Med Assoc 82:318–321. https://doi.org/10.1097/JCMA.0000000000000049

    Article  PubMed  Google Scholar 

  7. Boileau P, Krishnan SG, Tinsi L et al (2002) Tuberosity malposition and migration: reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus. J Shoulder Elbow Surg 11:401–412. https://doi.org/10.1067/mse.2002.124527

    Article  CAS  PubMed  Google Scholar 

  8. Christoforakis JJ, Kontakis GM, Katonis PG et al (2003) Relevance of restoration of humeral length and retroversion in hemiarthroplasty for humeral head fractures. Acta Orthop Belg 69:200–207

    Google Scholar 

  9. Kaziz H, Triki MA, Benzarti S, Chermiti W, Naouar N, Ayeche ML (2019) Comparison of reverse shoulder arthroplasty and hemiarthroplasty for proximal humeral fractures: what about functional outcome? Reverse versus hemiarthroplasty in shoulder fractures. Open J Orthop 9:112–122. https://doi.org/10.4236/ojo.2019.94011

    Article  Google Scholar 

  10. Boileau P, Walch G, Krishnan SG (2000) Tuberosity osteosynthesis and hemiarthroplasty for four-part fractures of the proximal humerus. Tech Shoulder Elbow Surg 1:96–109

    Article  Google Scholar 

  11. Saikia D, Frank H, Kesarwani S (2021) Outcomes of shoulder hemiarthroplasty in non-salvageable proximal humerus fracture: a prospective study. Int J Orthop Sci. 7:334–339. https://doi.org/10.22271/ortho.2021.v7.i3e.2769

    Article  Google Scholar 

  12. Krishnan SG, Pennington SD, Burkhead WZ, Boileau P (2005) Shoulder arthroplasty for fracture: restoration of the Gothic Arch. Tech Shoulder Elbow Surg 6:57–66. https://doi.org/10.1097/01.bte.0000156561.97672.ea

    Article  Google Scholar 

  13. Sahu SK, Verma D (2020) Primary shoulder hemiarthroplasty in the management of post traumatic proximal humerus fractures. Int J Orthop Sci. 6:475–479. https://doi.org/10.22271/ortho.2020.v6.i1i.1910

    Article  Google Scholar 

  14. Peters PM, Plachel F, Danzinger V et al (2019) Clinical and radiographic outcomes after surgical treatment of proximal humeral fractures with head-split component. J Bone Joint Surg Am 102:68–75. https://doi.org/10.2106/JBJS.19.00320

    Article  Google Scholar 

  15. Singh A, Padilla M, Nyberg EM et al (2017) Cement technique correlates with tuberosity healing in hemiarthroplasty for proximal humeral fracture. J Shoulder Elbow Surg 26:437–442. https://doi.org/10.1016/j.jse.2016.08.003

    Article  PubMed  Google Scholar 

  16. Krause FG, Huebschle L, Hertel R (2007) Reattachment of the tuberosities with cable wires and bone graft in hemiarthroplasties done for proximal humeral fractures with Cable Wire and bone graft: 58 patients with a 22-month minimum follow-up. J Orthop Trauma 21:682–686. https://doi.org/10.1097/bot.0b013e31815917e0

    Article  PubMed  Google Scholar 

  17. Macfarlane RJ, Ali Z, Datt D, Venkateswaran B (2010) Healing of the greater tuberosity in acute shoulder hemiarthroplasty using an accelerated rehabilitation regime. Should Elb 2:131–135. https://doi.org/10.1111/j.1758-5740.2010.00058.x

    Article  Google Scholar 

  18. Petscavage JM, Ha AS, Chew FS (2012) Current concepts of shoulder arthroplasty for radiologists: part 1-epidemiology, history, preoperative imaging, and hemiarthroplasty. Am J Roentgenol 199:757–767. https://doi.org/10.2214/ajr.12.8854

    Article  Google Scholar 

  19. Kummer FJ, Perkins R, Zuckerman JD (1998) The use of the bicipital groove for alignment of the humeral stem in shoulder arthroplasty. J Shoulder Elbow Surg 7:144–146. https://doi.org/10.1016/s1058-2746(98)90225-7

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

None.

Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Daejeon Sun Hospital, Daejeon, Korea

    In-Soo Song & Hyun Duck Choi

  2. Chungnam National University Hospital, Daejeon, Republic of Korea

    In-Soo Song

  3. University of Debrecen Medical and Health Science Center, Debrecen, Hungary

    Hyun Duck Choi

Authors
  1. In-Soo Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hyun Duck Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

The study conception and design were done by I-SS. Data collection and analysis were performed by HDC. The study’s original draft was written by HDC. All authors reviewed and edited the original draft of the manuscript. All authors reviewed and approved the final version of the manuscript.

Corresponding author

Correspondence to In-Soo Song.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

Ethical approval to report these cases was obtained from the Institutional Review Board of Daejeon Sun Hospital (DSH-인-23–02). The study conforms to the Declaration of Helsinki.

Informed consent

Written informed consent was obtained from the patient(s) for their anonymized information to be published in this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Song, IS., Choi, H.D. The long-term results of shoulder hemiarthroplasty in irreducible four-part fracture-dislocation of the proximal humerus without rotator cuff tear arthropathy. Eur J Orthop Surg Traumatol 34, 311–317 (2024). https://doi.org/10.1007/s00590-023-03604-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-023-03604-z

Keywords

Search

Navigation