One-stage artiifcial humeral head replacement for comminuted proximal humeral fractures in the elderly

WU Guang-sen; ZHAO Dong-sheng; HUANG Ai-wen; WU Yun-feng; WU Xiao-man; L Yan-lei; WANG Zhi-hua

doi:10.3969/j.issn.2095-252X.2015.02.07

Abstract：Objective To evaluate the clinical results of one-stage artiifcial humeral head replacement in the treatment of comminuted proximal humeral fractures in the elderly. Methods From December 2010 to October 2014, 19 patients with comminuted proximal humeral fractures were adopted and treated, whose mean age was 71.3 years old ( range:63-85 years ). There were 8 cases of Neer 3-part fractures and 11 cases of Neer 4-part fractures, accompanied by dislocation of the humeral head in 7 cases, brachial plexus injuries in 3 cases, ipsilateral distal radius fractures in 2 cases and ipsilateral femoral neck fracture in 1 case. Hypertension was noticed in 15 cases, type II diabetes in 13 cases and old and lacunar cerebral infarction in 6 cases. All the patients underwent humeral head replacement using the same prostheses of Bigliani/Flatow type produced by Zimmer company at 3-7 days after injuries. Early functional exercise was carried out after the surgery according to the Neer rehabilitation principles. The average follow-up time was 16.3 months. Pain severity and range of motion ( ROM ) of the joint were recorded, as well as the complications of dearticulation, prosthetic loosening and periprosthetic joint infections. The postoperative functions were evaluated according to the Constant-Murley scoring system. Results Fifteen patients had no pain and 4 patients had mild pain. No dearticulation, prosthetic loosening or periprosthetic joint infections were found. The mean postoperative functional score was 70.1, and the rate of subjective satisfaction was 78.9%. Conclusions Artiifcial humeral head replacement is a good choice in the treatment of comminuted proximal humeral fractures in the elderly, which can quickly relieve pain and restore joint function. There are many key factors that cannot be ignored, namely surgical indications, timing and techniques, functional exercise, etc.