Hemiarthroplasty in the management of the comminuted proximal humeral fractures
There are problems in the surgical treatment of the comminuted proximal humeral fractures since they are technically demanding and they have poor postoperative functional results. The most common problems are the disturbance of the vascular circulation, difficulty of the anatomic reconstruction and the difficulty to perform a stable osteosynthesis that will allow early rehabilitation. In the recent years these cases are treated with partial or total endoprosthesis. Our aim in this study is to discuss the prosthesis indications under the light of the cases of proximal humeral fractures which were treated with partial endoprosthesis. 18 cases who were treated with hemiarthroplasty because of proximal humeral fracture and whose follow-ups are sufficient are included in this study. 6 of our cases were male and 12 were female. Average age was 59.5 cases applied because of falling and 13 because of traffic accident. Posttraumatic average period was 1 month. The fracture classification was as 3 fracture dislocations, 8 Neer type IV, 5 Neer type III and 2 fracture dislocations with humeral shaft fractures. NEER type II cemented partial endoprosthesis was used in all our patients. Non-absorbable suture material was used in the fixation of the greater and lesser tubercles. The cases were taken in arm sling and the rehabilitation was begun on the postoperative sixth day. 18 cases whose follow-up periods were over one year was included in this study. When we evaluated the patients' pain, except one patient with moderate and one with occasional pain complaints, we did not note obvious pain. Except one patient all patients returned to their daily life. We noted one non-union on the greater tubercle radiologically. Except one patient we did not see any infections. One of the two brachial plexus lesions occurred at the trauma, healed after the operation. We did not see any neurological lesions depending on the operation. According to the COFIELD evaluation scores, 10 cases were excellent, 4 cases were good, 3 cases were moderate and one case was poor. Partial endoprosthesis in the comminuted proximal humeral fractures is more advantageous than the other surgical procedures, considering the pain, patient's pleasure and the functional results. Also, considering that this method is a choice of treatment in the comminuted humeral fractures.
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