Modified hemiarthroplasty for four-part fractures of the proximal humerus

Abstract

Background: Hemiarthroplasty is used to treat patients with Neer four-part fractures but the post-operative complication rate remains high, particularly with regard to shoulder joint instability. This study was aimed at evaluating the efficacy of a modified rotator cuff reconstruction and balance technique by comparing it with conventional rotator cuff restoration surgery for Neer four-part fractures. Methods: This retrospective therapeutic study included 67 patients with Neer four-part fractures. Forty-five patients underwent the modified surgery and 22 control patients underwent conventional surgery. All patients were followed up for more than 3 years. Outcome was assessed by grading clinical outcome and pain and strength, measuring range of motion, and radiographic analysis. Results: The Neer score was higher in the modified surgery group (84 versus 75; P = 0.009). The rate of satisfaction (Neer score ≥80) in the modified surgery group was higher than in the conventional surgery group (71.11% versus 40.91%; P = 0.017). Range of motion for active abduction, external rotation, internal rotation and active forward elevation was greater in the modified surgery group (all P < 0.01). The morbidity rate of post-operative instability of the shoulder joint in the modified surgery group was much lower than that in the conventional surgery group (2.22% versus 18.2%; P < 0.01). Conclusion: The modified hemiarthroplasty procedure for treatment of Neer four-part fractures prevents post-operative instability of the shoulder joint and improves function of the shoulder more effectively than the conventional hemiarthroplasty procedure. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.