Osteosynthesis and hemiarthroplasty of fractures of the proximal humerus: outcomes in a consecutive case series

Bastian, Johannes Dominik; Hertel, R (2009). Osteosynthesis and hemiarthroplasty of fractures of the proximal humerus: outcomes in a consecutive case series. Journal of shoulder and elbow surgery, 18(2), pp. 216-9. New York, N.Y.: Elsevier 10.1016/j.jse.2008.09.015

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HYPOTHESIS: This study addresses the outcome after osteosynthesis or hemiarthroplasty, using a cohort of patients that was enrolled in a previous prospective study on humeral head perfusion and was consequently treated using a common conceptual approach. MATERIALS AND METHODS: Between 1998 and 2001, 98 patients with 100 fractures of the proximal humerus were treated surgically by a single surgeon with open reduction and internal fixation (ORIF) (51/100, group A, median age 54 years; range, 21-88) or with hemiarthroplasty (49/100, group B, median age 66 years; range, 38-87). Seventy-six of 98 patients were available for re-evaluation at a mean follow-up of five years (3.3-7.3) using the Constant-Murley score (CMS), the Subjective Shoulder Value (SSV), and conventional radiographs. RESULTS: The median total CMS was 77 (range, 37-98) for group A and 70 (range, 39-84) for group B. The median SSV was 92 (range, 40-100) for group A and 90 (range, 40-100) for group B. Avascular necrosis occured in 6/40 fractures treated with ORIF. CONCLUSION: Osteosynthesis and hemiarthroplasty yield similar functional results and comparable patient satisfaction following the applied decision making process in this selected patient cohort. Osteosynthesis with preservation of the humeral head is worth considering when adequate reduction and stable conditions for revascularization can be obtained. In patients with osteopenic bone and/or comminuted fractures, hemiarthroplasty is a viable alternative. LEVEL OF EVIDENCE: Level 2; Prospective non-randomized comparison study.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Orthopaedic Surgery

UniBE Contributor:

Bastian, Johannes Dominik

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1058-2746

ISBN:

19101174

Publisher:

Elsevier

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 15:09

Last Modified:

24 Jul 2014 08:51

Publisher DOI:

10.1016/j.jse.2008.09.015

PubMed ID:

19101174

Web of Science ID:

000263692600011

URI:

https://boris.unibe.ch/id/eprint/30273 (FactScience: 191672)

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