Outcomes, and factors affecting outcomes, following shoulder hemiarthroplasty for proximal humeral fracture repair

Hemiarthroplasty has been applied to treat proximal humeral fracture with variable outcomes. The purpose of this retrospective study was to assess factors affecting outcome in patients following hemiarthroplasty for proximal humeral fracture (PHF) repair. Patients with proximal humeral fractures treated over a 6-year period were included. Indications for hemiarthroplasty were severe three-part fractures associated with osteoporosis; four-part fractures with or without dislocation; splitting of the humeral head, or > 45% collapse of the humeral head. Surgery outcome and postoperative complications were main outcome measures in this study. Thirty-three of 47 patients were included in the final analysis (mean age 64.3 years, range 43-82). Mean postoperative follow-up was 44.4 (range 36-57) months. Postoperative complications (shoulder dislocation, mild shoulder subluxation, heterotopic ossification) occurred in seven patients. Healing of the greater and lesser tubercles was abnormal or poor in 18 patients. These patients had significantly higher pain scores (4.0 +/- A 1.1 vs. 2.2 +/- A 1.1) and significantly lower capacities for active lifting (79.3 +/- A 9.6 vs. 121.7 +/- A 24.3), external rotation (20.7 +/- A 3.7 vs. 39.2 +/- A 10.3), and Neer scores (79.2 +/- A 5.7 vs. 90.6 +/- A 3.6) versus patients who exhibited complete healing (all P < 0.001). Patient age, type of surgical approach, and fracture type were not major influencers of outcome. In conclusion, the healing of the greater and lesser tubercles is the major determinant of outcome following hemiarthroplasty for PHF repair.