Department of Shoulder and Elbow Surgery, ATOS Clinic Heidelberg, Heidelberg, Germany; Department of Orthopedic and Trauma Surgery, University Hospital Cologne, Cologne, Germany.
Department of Shoulder and Elbow Surgery, ATOS Clinic Heidelberg, Heidelberg, Germany.
J Shoulder Elbow Surg. 2023 Sep;32(9):1909-1917. doi: 10.1016/j.jse.2023.02.118. Epub 2023 Mar 11.
Vitality-threatening proximal humerus fractures often provide an indication for prosthetic treatment. We investigated the issue of how anatomic hemiprostheses perform in younger, functionally challenging patients with the use of a specific fracture stem and systematic tuberosity management in medium-term follow-up.
Thirteen skeletally mature patients with a mean age of 64 ± 9 years and a minimum follow-up of 1 year after primary open-stem hemiarthroplasty for 3- and 4-part proximal humeral fractures were included. All patients were followed up regarding their clinical course. Radiologic follow-up included fracture classification, healing of tuberosities, proximal migration of the humeral head, evidence of stem loosening, and glenoid erosion. Functional follow-up included range of motion, pain, objective and subjective performance scores, complications, and return to sports rates. We statistically compared treatment success based on the Constant score between the cohort with proximal migration and the cohort with regular acromiohumeral distance by means of the Mann-Whitney U test.
After an average follow-up period of 4.8 years, satisfactory results were obtained. The absolute Constant-Murley score was 73.2 ± 12.4 points. The disabilities of the arm, shoulder, and hand score was 13.2 ± 13.0 points. Patients reported their mean subjective shoulder value as 86.6% ± 8.5%. Pain was reported as 1.1 ± 1.3 points on a visual analog scale. Flexion, abduction, and external rotation values were 138 ± 31°, 134 ± 34°, and 32 ± 17°, respectively. 84.6% of the referred tuberosities healed successfully. Proximal migration was observed in 38.5% of cases and was associated with worse Constant score results (P = .065). No patient showed signs of loosening. Mild glenoid erosion was apparent in 4 patients (30.8%). All patients who were interviewed and participated in sports before surgery were able to return to their primary sport after surgery and continued to do so during the final follow-up.
With narrow indications, use of a specific fracture stem and adequate tuberosity management, successful radiographic and functional results are presented after a mean follow-up of 4.8 years after hemiarthroplasty for primary nonreconstructable humeral head fractures. Accordingly, open-stem hemiarthroplasty appears to remain a possible alternative to reverse shoulder arthroplasty in younger, functionally challenging patients with primary 3- or 4-part proximal humeral fractures.
危及生命的肱骨近端骨折常需要进行假体治疗。我们研究了在使用特定骨折柄和系统结节管理的情况下，解剖半关节假体在年轻、功能要求高的患者中的表现，这些患者的随访时间为中期。
纳入了 13 例骨骼成熟的患者，平均年龄 64±9 岁，在初次开放性柄半关节成形术治疗 3 部分和 4 部分肱骨近端骨折后至少随访 1 年。所有患者均随访其临床病程。影像学随访包括骨折分类、结节愈合、肱骨头近端迁移、柄松动证据和肩胛盂侵蚀。功能随访包括活动范围、疼痛、客观和主观表现评分、并发症和重返运动率。我们通过 Mann-Whitney U 检验，根据 Constant 评分，比较近端迁移组和常规肩峰肱距组的治疗成功率。
平均随访 4.8 年后，获得了满意的结果。绝对 Constant-Murley 评分 73.2±12.4 分。手臂、肩部和手部残疾评分 13.2±13.0 分。患者报告的平均主观肩部值为 86.6%±8.5%。疼痛在视觉模拟评分上为 1.1±1.3 分。屈曲、外展和外旋值分别为 138±31°、134±34°和 32±17°。84.6%的转诊结节成功愈合。38.5%的病例出现近端迁移，与较差的 Constant 评分结果相关（P=0.065）。无患者出现松动迹象。4 例（30.8%）出现轻度肩胛盂侵蚀。所有接受访谈并在术前参加运动的患者均能在术后恢复到主要运动，并在最终随访时继续参加。
在严格适应证的情况下，使用特定的骨折柄和适当的结节管理，在初次非重建性肱骨头骨折行半关节成形术后平均随访 4.8 年后，可获得成功的影像学和功能结果。因此，在年轻、功能要求高的 3 部分或 4 部分肱骨近端骨折患者中，开放性柄半关节成形术似乎仍然是反向肩关节置换术的一种可行替代方法。
