Background. The purpose of this study was to report our experience with shoulder hemiarthroplasty in the context of old trauma. Methods. 33 patients with failed treatment for a complex proximal humeral fracture underwent prosthetic hemiarthroplasty. There were 15 men and 18 women with a mean age of 58.1 years. The average period from initial treatment was 14.9 months. Sequelae included 11 malunions, 4 nonunions, 15 cases with avascular necrosis (AVN) and 3 neglected posterior locked dislocations. Follow up investigation included radiological assessment and clinical evaluation using the Constant score and a visual analogue pain scale. Results. After a mean follow up of 82.5 months the median Constant score was 75.7 points, improved by 60% in comparison to preoperative values. Greater tuberosity displacement, large cuff tears and severe malunion were the factors most affected outcome. No cases of stem loosening or severe migration were noted. 60% of the patients were able to do activities up to shoulder level compared with 24% before reconstruction. Conclusions. Late shoulder hemiarthroplasty is technically difficult and the results are inferior to those reported for acute humeral head replacement, nonetheless remains a satisfactory reconstructive option when primary treatment fails. 1. Introduction Shoulder hemiarthroplasty is a technically challenging procedure which can predictably restore shoulder-level function in patients with 4-part fractures, some 3-part fractures, fracture dislocations, head-splitting fractures, and impaction fractures of the humeral head with involvement of more than 50% of the articular surface [1–4]. Early surgical intervention within 2 weeks postinjury, accurate tuberosity reconstruction, and appropriate height and retroversion of the prosthesis are the factors with the greatest impact on functional outcome [5–8]. In contrast, outcomes of internal fixation [9, 10] and nonoperative treatment [11, 12] for these complex fractures are quite controversial, with the initial management considered critically important. Krappinger et al. [13] showed in a recent study that multifragmentary fracture patterns in old patients with low local BMD are prone for fixation failure. Revision osteosynthesis or late prosthetic shoulder arthroplasty in these complex fractures is fraught with complications, and functional results are usually disappointing [14, 15]. Bone loss, malunion, ectopic ossification, avascular necrosis, associated rotator cuff tears, and severe contractions of soft tissues are some of the factors that prevent appropriate
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