J Korean Orthop Assoc.  2012 Aug;47(4):243-249. 10.4055/jkoa.2012.47.4.243.

Arthroplasty for Fractures of the Proximal Part of the Humerus

• Jung HJ
• Jeon IH
• Chun JM

• KMID: 2185370
• DOI: http://doi.org/10.4055/jkoa.2012.47.4.243

Abstract

Comminuted proximal humeral fractures with displaced three- or four-part fragments, fracture-dislocations, and humeral head-splitting fractures are very difficult to treat. In older patients, hemiarthroplasty or reverse shoulder arthroplasty is often the indicated treatment. Arthroplasty in this patient cohort is a very technique-dependent procedure, and relies on preserving deltoid function, proper component placement and fixation, and tuberosity fixation. Although pain relief is predictable, it is often difficult to achieve functional improvement. Results depend on the patient's age, timing of the surgery, tuberosity healing, and adequate rehabilitation.

Keyword

shoulder; fractures of proximal humerus; arthroplasty

MeSH Terms

Arthroplasty
Cohort Studies
Hemiarthroplasty
Humans
Humerus
Shoulder
Shoulder Fractures

Figure

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  Figure 1 (A) Nonabsorbable sutures are placed at the junction of the tendon-tuberosity interface and are not through the tuberosities. (B) Once the native humeral head is removed, the tuberosities with their respective rotator cuff attachments are mobilized for humeral canal preparation and later repair.

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  Figure 2 The anterior fin of the prosthesis is aligned with the forearm in neutral rotation, and the lateral fin is positioned approximately 8 mm posterior to the biceps groove, establishing a retroversion angle of approximately 30 degrees.

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  Figure 3 Reduction of the tuberosity to determine the height of the prosthetic head, which should be 5 to 8 mm above the top of the greater tuberosity.

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