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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
PAPERS ON SHOULDER
Minerva Ortopedica e Traumatologica 2006 August;57(4):389-92
Prosthetic treatment of complex proximal humeral fracture in old patients: anatomic versus inverted prosthesis
Giovale M., Caione G., Dynamidis S., Franchin F.
Clinica Ortopedica Università degli Studi di Genova, Genova
Aim. The prosthetic treatment of proximal humeral fracture represent a continuous challenge for the orthopaedic surgeons. The aim of this study is to evaluate the outcome of shoulder prosthesis implanted in our clinic for the treatment of proximal humeral fractures in patients over 75 years old. This study was conducted from 2000 to 2005.
Methods. We have considered in our follow-up 28 anatomic shoulder prosthesis and 4 inverted prosthesis implanted in patients over 75 years old. Radiographic evaluation was made by execution of standard RX in neutral, intra and external rotation. Clinical evaluation was made by utilising the Constant score scale.
Results. We have evaluated for this study 32 patients, 25 women and 7 men with a mean age of 78.4 (range 75-92) and a mean follow-up of 29 months. X-rays show 14 cases of good consolidation of the humeral tuberosities in an anatomical position, 9 cases of tuberosities malunion and 5 cases of complete tuberosities reabsorbtion. The mean Constant score was 51.8.
Conclusions. Negative out-come in shoulder prosthesis for the treatment of humeral fractures is unforeseeable. We obtained best results in patients with a good bone stock and in those who followed the rehabilitation program with great motivation. For this reason we recommend the implant of a reversed shoulder prosthesis especially in old patients with poor bone stock, with multiple tuberosities fractures and with no motivation to follow the long rehabilitation program.