The Journal of Bone and Joint Surgery, Vol 74, Issue 6 884-889, Copyright © 1992 by Journal of Bone and Joint Surgery, Inc
Modular hemiarthroplasty for fractures of the proximal part of the humerus
BH Moeckel, DM Dines, RF Warren and DW Altchek
Shoulder Service, Hospital for Special Surgery, New York City, N.Y. 10021.
A new biomodular prosthesis was used for the treatment of a displaced
fracture of the proximal part of the humerus in twenty-two shoulders in
twenty-two patients. The fractures were classified according to the Neer
system; there were thirteen four-part, five three-part, and four
head-splitting fractures. There were fifteen women and seven men, and the
mean age was seventy years (range, forty-nine to eighty-seven years). The
hemiarthroplasty was performed an average of eleven days (range, one to
forty-five days) after the injury. The deltopectoral interval was used in
all patients, and the prosthesis was implanted with cement in twenty of the
shoulders. All of the patients participated in a supervised program of
rehabilitation. The patients were followed for an average of thirty-six
months (range, twenty-six to forty-nine months). Twenty of the twenty-two
patients had a good or excellent result. The active forward elevation
averaged 119 degrees; external rotation, 40 degrees; and internal rotation,
to the twelfth thoracic vertebra. All of the patients except for the two
who had a poor result had satisfactory relief of pain. The two patients who
had a poor result had a successful revision with a modular prosthesis of
the same design. The modular head could be removed, enabling the surgeon to
gain access to the glenoid and to adjust the soft tissues. The over-all
scores correlated inversely with the age of the patients and the interval
from the injury to the operation.(ABSTRACT TRUNCATED AT 250 WORDS)
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