Primary Joint Replacement in Proximal Humeral Fractures

Abstract

The surgical treatment of proximal humeral fractures constitutes a great challenge. Not all fracture types can be successfully reconstructed. Indications for a primary joint replacement arise from critical fracture patterns and defined ischemia-predicting criteria in the elderly. Good functional results are received by a soft-tissue preserving surgical technique, a secure tuberosity attachment and accurate soft tissue balancing of the rotator cuff, a correct restoration of height, retrotorsion and offset, and an appropriate aftertreatment. Multicenter studies observed an averaged Constant Murlay Score of 56 to 73.5 points. 79% of the patients had no or only mild pain in the follow up, ROM was acceptable (41.9% Anteversion >90°, 34.7% Abduction >90°). Generally, subjective evaluations are much better than objective results. The incidence of complications after primary humeral head replacement is still relatively high, whereas the 10-year-survival-rate of shoulder hemiarthroplasties was found to be 100%, currently.