A Hospital Based Prospective Study To Evaluate The Outcome Of Shoulder Hemi-Replacement In Four-Part Fracture And Four- Part Fracture Dislocation Of Proximal Humerus

Background and objective: Proximal humerus is the second most common site of fracture in the upper limb. The four-part proximal humerus fractures are severe and complex, make the management challenging especially in elderly. However controversy exists regarding the optimum treatment for four-part fracture and four-part fracture dislocation. The present study describes the efficacy of functional outcome of shoulder hemi arthroplasty in patients with four-part fracture and four-part fracture dislocation. Materials and methods: This one year prospective study was done from January 2014 to December 2014 in the Department of Orthopaedics situated in a tertiary care hospital of north Karnataka, India. A total of 20 patients aged ≥ 60 years with four-part proximal humerus fracture with or without dislocation were studied. Patients underwent primary shoulder hemi arthroplasty and were followed at six weeks, three months and six months. The outcome was assessed based on Constant shoulder score. Result: We reviewed 20 shoulders treated with hemiarthroplasty at interval of 6 weeks, 3 months and 6 months. Average Constant score of all 20 patients post-operatively at the end of 6 months was found to be 71.05± 18.50, which was suggestive of good outcome in study population. All patients had painless movements at the shoulder joint and were satisfied with the range of movements. Radiographic evaluation revealed anatomic tuberosity reconstruction in 9 shoulders. Primary causes for poor outcome in terms of pain and range of movements was due to rotator cuff degenerative changes in elderly patients, non-compliance for post op physiotherapy and comminuted proximal humerus fracture with dislocation. Overall functional outcome found to be excellent in 25%, good in 35%, moderate in 30% and poor in 10%. Conclusion: It may be concluded that primary shoulder hemiarthroplasty for the treatment of four-part proximal humerus fracture with or without dislocation leads to a satisfactory functional outcome in most of the patients. The results were comparable to other studies with respect to mechanism of injury, type of fracture, side involved and Neer’s classification of proximal humerus. Rotator cuff degenerative changes in these elderly patients was found to be a strong predictor of poor outcome followed by non compliance to post op physiotherapy protocol. Hence primary shoulder hemi-arthroplasty is an ideal treatment for Neer’s four-part fracture with or without dislocation in elderly patients hence allowing early mobilization of the shoulder with good range of movements.