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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
UPDATES ON SHOULDER ARTHROPLASTY 102nd CONGRESS OF THE PIEMONTESE-LIGURIAN-LOMBARD SOCIETY OF ORTHOPEDICS AND TRAUMATOLOGY (S.P.L.L.O.T.) - Brescia September 9-10, 2005
NEW TECHNOLOGIES, MODERN INSTRUMENTARIUM IN ARTHROPLASTIC SURGERY
Minerva Ortopedica e Traumatologica 2005 August;56(4):315-20
Hemiarthroplasty in the treatment of proximal humeral fractures
Assom M., Fumero S., Castoldi F., Blonna D.
Terzo Dipartimento di Ortopedia e Traumatologia Università degli Studi di Torino, Torino Ospedale Mauriziano Umberto I, Torino
The treatment of complex proximal humeral fracture remains controversial. This is especially due to the difficulty to compare results from differents reports. After preoperative imaging interobserver reliability and intraobserver reproducibility score are disappointingly low even with the most widely accepted classification systems. Hence, standard preoperative imaging, alone, is not sufficient to accuratly define the indications for hemiarthroplasty that often require intraoperative confirmation. A precise definition of segments and the exact amount of displacement are important predictors of humeral head ischemia, but not of humeral necrosis. Neither the diagnosis of a four-part fractures, nor fracture-dislocations, head-spitting fractures, large impression fractures, calcar involvement and a disrupted medial hinge, are helpful to precisely predict necrosis, or low functional results after osteosynthesis. According to these observations, we suggest reduction and fixation as initial treatment in patients of less than 70 years with three- and four-part fractures and fracture-dislocations; we performed hemiarthroplasty in patients who have persistent late pain secondary to the fractures. Nevertheless prosthetic replacement should be recommended immediately after trauma in patient older than 70 years with osteopotic bones, poor bone stock, high risk of head ischemia or in case of intrarticular involvement.