| Primary hemiarthroplasty for treatment of proximal humeral fractures. | |
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MedLine Citation:
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PMID: 12851345 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Primary hemiarthroplasty of the shoulder is used to treat complex proximal humeral fractures, although the reported functional results following this method of treatment have varied widely. The aim of this study was to prospectively assess the prosthetic survival and functional outcomes in a large series of patients treated with shoulder hemiarthroplasty for a proximal humeral fracture. By determining the factors that affected the outcome, we also aimed to produce models that could be used clinically to estimate the functional outcome at one year following surgery. METHODS: A thirteen-year observational cohort study of 163 consecutive patients treated with hemiarthroplasty for a proximal humeral fracture was performed. Twenty-five patients died or were lost to follow-up in the first year after treatment, leaving 138 patients who had assessment of shoulder function with use of the modified Constant score at one year postinjury. RESULTS: The overall rate of prosthetic survival was 96.9% at one year, 95.3% at five years, and 93.9% at ten years. The overall median modified Constant score was 64 points at one year, with a typically good score for pain relief (median, 15 points) and poorer scores, with a greater scatter of values, for function (median, 12 points), range of motion (median, 24 points), and muscle power (median, 14 points). Of the factors that were assessed immediately after the injury, only patient age, the presence of a neurological deficit, tobacco usage, and alcohol consumption were significantly predictive of the one-year Constant score (p < 0.05). Of the factors that were assessed at six weeks postinjury, those that predicted the one-year Constant score included the age of the patient, the presence of a persistent neurological deficit, the need for an early reoperation, the degree of displacement of the prosthetic head from the central axis of the glenoid seen radiographically, and the degree of displacement of the tuberosities seen radiographically. CONCLUSIONS: Primary shoulder hemiarthroplasty performed for the treatment of a proximal humeral fracture in medically fit and cooperative adults is associated with satisfactory prosthetic survival at an average of 6.3 years. Although the shoulder is usually free of pain following this procedure, the overall functional result, in terms of range of motion, function, and power, at one year varies. A good functional outcome can be anticipated for a younger individual who has no preoperative neurological deficit, no postoperative complications, and a satisfactory radiographic appearance of the shoulder at six weeks. The results are poorer in the larger group of elderly patients who undergo this procedure, especially if they have a neurological deficit, a postoperative complication requiring a reoperation, or an eccentrically located prosthesis with retracted tuberosities. |
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Authors:
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C Michael Robinson; Richard S Page; Richard M F Hill; David L Sanders; Charles M Court-Brown; Alison E Wakefield |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The Journal of bone and joint surgery. American volume Volume: 85-A ISSN: 0021-9355 ISO Abbreviation: J Bone Joint Surg Am Publication Date: 2003 Jul |
Date Detail:
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Created Date: 2003-07-09 Completed Date: 2003-07-25 Revised Date: 2010-10-25 |
Medline Journal Info:
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Nlm Unique ID: 0014030 Medline TA: J Bone Joint Surg Am Country: United States |
Other Details:
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Languages: eng Pagination: 1215-23 Citation Subset: AIM; IM |
Affiliation:
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Edinburgh Orthopaedic Trauma Unit, The Royal Infirmary of Edinburgh, United Kingdom. c.mike.robinson@ed.ac.uk |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Accidental Falls Accidents, Traffic Activities of Daily Living Adult Age Factors Aged Aged, 80 and over Alcohol Drinking / adverse effects Analysis of Variance Arthroplasty, Replacement / adverse effects, instrumentation, methods* Female Follow-Up Studies Humans Linear Models Male Middle Aged Predictive Value of Tests Prosthesis Failure Range of Motion, Articular Recovery of Function Reoperation Risk Factors Shoulder Fractures / etiology, physiopathology, surgery* Shoulder Joint / surgery* Smoking / adverse effects Survival Analysis Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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