Abstract:
Background: Three- and four part fractures and fracture dislocation of the proximal humerus in elderly patients remain a challenging problem to Orthopaedic surgeons. Secure fixation of such fractures is difficult in elderly patients with osteoporotic bone. Also The risk of secondary displacement of the fragments and necrosis of the head of the humerus after open reduction and internal fixation is high. Primary shoulder hemiarthroplasty is a good alternative to overcome those difficulties and can give a satisfactory outcome in elderly patients.
Patients and methods: Functional outcome was measured following modular Shoulder hemiarthroplasty in three- and four part fractures of the proximal humerus in elderly patients. Thirteen patients have received modular shoulder hemiarthroplasty four to seven days (mean 5.4) following the injury. Deltopectoral approach was used in all patients. All patients participated in a supervised programme of rehabilitation. Patients were followed for a mean of 17 months (12 to 24) for clinical and radiological assessment. Twelve patients were available for follow up and the functional outcome was assessed according to the Constant score, the Abbreviated Constant score and the Oxford score (Questionnaire) .
Results: Five patients had poor results according to Constant score (scored less than 70% of the score). However the results were better when measured with the Abbreviated Constant score and Oxford score (10, 12 patients scored 70% or more of both scores respectively).All of the patients had satisfactory relief of pain inspite of poor function in some cases.
Conclusion: The results of this study are supporting the concept of using modular shoulder hemiarthroplasty in three- and four part fractures and fracture dislocation of the proximal humerus in selected patients over 65 years of age.
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