Hemiarthroplasty for complex fractures of the proximal humerus: surgical technique and results with the Atlas trimodular prosthesis.

The use of the Atlas trimodular prosthesis (Biomet, Inc., Warsaw, Indiana) to treat complex proximal humeral fractures in the acute and chronic setting is described. This prosthesis comprises an independent shaft, neck and head; its high degree of modularity allows the surgeon to match the local anatomy more precisely when sizing the prosthesis. The indications and contraindications for hemiarthroplasty for acute proximal humerus fractures are discussed, together with surgical technique for these fractures and for chronic proximal humerus fractures. Also addressed are chronic posterior fracture-dislocations and the results of arthroplasty for chronic complex fractures of the proximal humerus. Satisfactory results are dependent on proper surgical technique, compliance of the patient with rehabilitation and the absence of postoperative complications.