[Primary shoulder arthroplasty for treatment of complex proximal humeral fractures with the trabecular metal prosthesis].

ABSTRACT

OBJECTIVE: To evaluate the clinical results of primary shoulder arthroplasty for the treatment of complex proximal humeral fractures with the trabecular metal prosthesis. METHODS: In the study, 57 consecutive patients with complex proximal humeral fractures underwent primary shoulder arthroplasty with the trabecular metal prosthesis, of whom 45 patients were available for the final follow-up (78.9%), and were retrospectively assessed. There were 15 men and 30 women with the average age of (64.9±10.6) years (range 45 to 85 years), and 14 left shoulders and 31 right shoulders were involved. The mean time from injury to surgery was (10.2±4.8) days. According to Neer's classification, there were 3 patients with a three-part fracture, 4 with a three-part dislocation, 2 with a four-part fracture, 22 with a four-part dislocation, 4 with a four-part valgus-impaction, and 10 with a head splitting. Thirty-nine patients were treated with hemiarthroplasty, and the rest with total shoulder arthroplasty. RESULTS: After a mean follow-up time of (18.7±8.1) months (range 12 to 41 months), the average range of motion of patients were 130.4°±36.5° for forward elevation, 37.6°±16.6° for external rotation and L3 level (±3 vertebrae) for internal rotation. The average VAS pain score, ASES score, Constant-Murley score and UCLA score were 0.5±1.2 (0-4), 81.4±13.9 (43-100), 81.6±13.6 (52-100) and 28.5±5.1 (16-35), respectively. The average patient satisfaction rate was 95.6%. The greater tuberosity healed anatomically in 42 patients, which was confirmed by the postoperative radiographs, while the greater tuberosity nonunion was found in the other three patients. Superior migration of humeral head was found in two patients. There were no complications, such as infection, prosthetic loosening or neurovascular injury, related to the surgery. CONCLUSION: Primary shoulder arthroplasty for complex proximal humeral fractures with the trabecular metal prosthesis could yield good clinical results. The healing rate of the greater tuberosity was 93.3%.