Shoulder hemiarthroplasty for complex humeral fractures: A 5 to 10-year follow-up retrospective study

Background: Shoulder hemiarthroplasty is considered a standard treatment in case of complex proximal humeral fractures. However, great variability affects the clinical outcomes. In this work, we examined the clinical and radiographic outcomes in a series of patients treated with hemiarthroplasty for 3- and 4-part humeral fractures and focused on factors affecting the final result. Materials and methods: In this study, we included 27 patients who had received a shoulder hemiarthroplasty between 2001 and 2005 at our institution. These patients were evaluated at an average of 7.2 years after surgery. All patients were managed within 10 days from trauma by the same surgeon and underwent the same time-scheduled rehabilitation program. Average age at surgery was 71.9 years. Results: Implant survival was 88.9 %. At the latest follow-up, mean DASH and SST-12 scores were 26.8 and 6.5, respectively. Mean Constant-Murley score was 52.4. Tuberosities complications and reduction in the acromion-humeral distance were negatively related to clinical outcome. Age at surgery displayed a negative correlation with clinical outcome, despite not reaching the statistical significance. This is mainly due to great variability in the elder group of patients. Conclusions: Shoulder hemiarthroplasty is a useful and effective solution for complex humeral fractures, with good results in the majority of patients. However, outcomes display a great variability in relation to X-ray alterations and age at surgery. A careful attention in patient selection is needed in order to standardize the clinical results associated with this kind of prosthetic implant. © 2014 Istituto Ortopedico Rizzoli.