Strength and motion after hemiarthroplasty in displaced four-fragment fracture of the proximal humerus: 27 patients followed for 1-6 years

We evaluated 27 patients with shoulder hemiarthroplasty after displaced four-fragment fracture of the proximal humerus after mean 4 (1-6) years. Isometric strength measurements (Kintrex) and threedimensional motion analysis (Elite-System) were performed on the operated and unoperated shoulders. Clinical assessment was based on Constant's score and Neer's scoring system. The isometric strength of the operated and unoperated sides were 22 (SD 8.6) Nm and 24 (SD 5.9) Nm in abduction and 48 (SD 14) Nm and 65 (SD 21) Nm, respectively in adduction (the latter was statistically significant). Motion analyses at follow-up showed a mean reduction in glenohumeral movement. Increases in acceleration and deceleration of the acromion at the operated side were noted, indicating a change in glenohumeral rhythm during maximal abduction. The Constant score was 45 (SD 15) points with a significant reduction in the range of motion. 15 patients had some degree of heterotopic ossification. On the basis of our findings, the impaired function seems to be caused by reduced glenohumeral mobility rather than muscle strength. We also found a better outcome after early than late hemiarthroplasty.     

Strength and motion after hemiarthroplasty in displaced four-fragment fracture of the proximal humerus: 27 patients followed for 1-6 years

We evaluated 27 patients with shoulder hemiarthroplasty after displaced four-fragment fracture of the proximal humerus after mean 4 (1-6) years. Isometric strength measurements (Kintrex) and three-dimensional motion analysis (Elite-System) were performed on the operated and unoperated shoulders. Clinical assessment was based on Constant's score and Neer's scoring system. The isometric strength of the operated and unoperated sides were 22 (SD 8.6) Nm and 24 (SD 5.9) Nm in abduction and 48 (SD 14) Nm and 65 (SD 21) Nm, respectively in adduction (the latter was statistically significant). Motion analyses at follow-up showed a mean reduction in glenohumeral movement. Increases in acceleration and deceleration of the acromion at the operated side were noted, indicating a change in glenohumeral rhythm during maximal abduction. The Constant score was 45 (SD 15) points with a significant reduction in the range of motion. 15 patients had some degree of heterotopic ossification. On the basis of our findings, the impaired function seems to be caused by reduced glenohumeral mobility rather than muscle strength. We also found a better outcome after early than late hemiarthroplasty.     

Outcome after cup hemiarthroplasty in the rheumatoid shoulder: A retrospective evaluation of 39 patients followed for 2-6 years

33 rheumatoid patients, treated with hemispherical cup resurfacing hemiarthroplasty of the shoulder without medullary fixation (6 bilaterally), were reviewed after mean 4.4 (2-6) years. The median Constant score was 30 (15-79), mean proximal migration of the humerus 5.5 (SD 5.2) mm and mean glenoid erosion 2.6 (SD 1.7) mm. Proximal migration and glenoid erosion did not correlate with shoulder function or pain. Radiographic signs of loosening (changes in cup inclination combined with changes in cup distance above the greater tuberosity) occurred in one quarter of the shoulders. At follow-up, 26 patients were satisfied with the procedure, despite poor shoulder function and radiographic deterioration.     

Function after early radial head resection for fracture: A retrospective evaluation of 15 patients followed for 3-18 years

We reviewed the results of early radial head resection in 15 patients after fracture of the radial head or neck: 4 Mason's type II fractures and 11 Mason's type III fractures. The average age at operation was 41 years and the patients were reexamined after mean 10 (3-18) years. Only 5 patients had no pain and all patients had reduced elbow power, in several of them a substantial loss.     

Outcome after cup hemiarthroplasty in the rheumatoid shoulder: a retrospective evaluation of 39 patients followed for 2-6 years

33 rheumatoid patients, treated with hemispherical cup resurfacing hemiarthroplasty of the shoulder without medullary fixation (6 bilaterally), were reviewed after mean 4.4 (2-6) years. The median Constant score was 30 (15-79), mean proximal migration of the humerus 55 (SD 5.2) mm and mean glenoid erosion 2.6 (SD 1.7) mm. Proximal migration and glenoid erosion did not correlate with shoulder function or pain. Radiographic signs of loosening (changes in cup inclination combined with changes in cup distance above the greater tuberosity) occurred in one quarter of the shoulders. At follow-up, 26 patients were satisfied with the procedure, despite poor shoulder function and radiographic deterioration.     

Function after early radial head resection for fracture: a retrospective evaluation of 15 patients followed for 3-18 years

We reviewed the results of early radial head resection in 15 patients after fracture of the radial head or neck: 4 Mason's type II fractures and 11 Mason's type III fractures. The average age at operation was 41 years and the patients were reexamined after mean 10 (3-18) years. Only 5 patients had no pain and all patients had reduced elbow power, in several of them a substantial loss.     

Medium-term results after primary hemiarthroplasty for comminute proximal humerus fractures: a study of 46 patients followed up for an average of 4.4 years

This study investigated 82 patients who underwent primary hemiarthroplasty for a severely displaced proximal humerus fracture at Danderyd Hospital between 1989 and 2002. According to the Neer classification system, fractures were 2-part in 2, 3-part in 20, and 4-part in 60. The prostheses used were 12 Neer-II, 39 Global, and 31 Bigliani-Flatow. Follow-up time averaged 4.4 years (range, 1-14 years). Twenty-two patients died, 9 were contacted by phone, and 5 were lost to follow-up. Forty-six patients underwent clinical examination, including the Constant score (CS) and radiographic examination. Mean CS for all patients was 42 of 100 points (range, 11-83 points). Radiologic evaluation revealed that 24 prostheses had migrated superiorly; this finding decreased the CS significantly. Ectopic bone developed in 25 patients, 16 had glenoid erosion, and 5 had displaced tuberosities; no correlation was found with the CS. Hemiarthroplasty usually prevented shoulder pain, but most patients had moderate function and poor strength. The reduced function appeared to be related to a lack of rotator cuff integrity.     

锁定接骨板治疗老年肱骨近端骨折

目的 探讨肱骨近端锁定接骨板(LPHP)治疗肱骨近端骨折的临床疗效。方法 采PHP治疗29例肱骨近端骨折，按Neer分类法，二部分骨折11例；三部分骨折12例；四部分骨折6例。结果 平均愈合时间7．4周(6～12周)：按照Constant评分标准，功能优18例，良为8例，中为3例，优良率为89．6％。结论 肱骨近端锁定接骨板治疗眩骨近端骨折手术简单、固定可靠、并发症少、骨折愈合率高特别是老年骨质疏松患者首选治疗方法。     

Outcome after primary hemiarthroplasty for fracture of the head of the humerus. A retrospective multicentre study of 167 patients

We have examined 167 patients who had a hemiarthroplasty for three- and four-part fractures and fracture-dislocations of the head of the humerus in a multicentre study involving 12 Austrian hospitals. All patients were followed for more than a year. Anatomical healing of the tuberosity significantly influenced the outcome as measured by the Constant score and subjective patient satisfaction. With regard to pain, the outcome was generally satisfactory but only 41.9% of patients were able to flex the shoulder above 90 degrees. The age of the patient and the type of prosthesis significantly influenced the healing of the tuberosity, but bone grafting did not. Achievement of healing of the tuberosity was inferior in institutions at which less than 15 hemiarthroplasties had been performed (Mann-Witney U test, p = 0.0001).     

Results of shoulder hemiarthroplasty in patients with acute and old fractures of the proximal humerus]

STUDY-DESIGN: We report on a prospective study of 22 patients after shoulder hemiarthroplasty in acute and old proximal humerus fractures. METHOD: Nine patients with an acute and 13 with an old humerus fracture, in whom a hemiarthroplasty was performed have been evaluated clinically using the Constant score as well as radiologically on average 22 months postoperatively. RESULTS: The mean Constant score improved on 28 points (27 to 55). The improvement was especially distinct in the group with acute fractures. Sixteen of the twenty examined patients were painfree. Two patients reported sleeping disturbances due to pain. The ROM was improved, especially in forward elevation and abduction. In two patients with an old fracture the results were less satisfying. Major complications could not be observed. In five cases X-ray revealed an atrophy of the fixated fragments. Dislocations did not occur. Radiological changes of the glenoid, already seen preoperatively became more obvious. Some humeral components, inserted without cement, showed "densification lines". There were no clinical signs of loosening. CONCLUSION: By performing hemiarthroplasty pain relief can be achieved, especially in old fractures. The postoperatively achieved joint function mainly depends on the type of fracture as well as ist age. In cases with a destroyed glenoid we now prefer to perform a total arthroplasty. In our opinion, general cement use for shaft fixation is not necessary.     

Open fractures of the proximal humerus treated with the Ilizarov method: 12 patients followed 3-8 years

We followed 12 patients who had been treated with the Ilizarov method for open proximal humeral fractures for more than 3 years. No wound infection occurred. Avascular necrosis and nonunion were each detected in 1 patient. According to Neer's criteria, the outcome was excellent or satisfactory in 8 patients.     

Periprosthetic proximal bone loss after uncemented hip arthroplasty is related to stem size: DXA measurements in 138 patients followed for 2-7 years

Background Periprosthetic bone loss occurs around uncemented femoral stems and may be influenced by the stem size.

Patients and methods We studied 138 consecutive patients, 3 (2-7) years on average after a total hip arthroplasty operation (THA) for unilateral osteoarthritis with the Bi-Metric uncemented femoral stem. We analyzed Harris hip score and bone mineral density.

Results The mean Harris hip score was 97 at follow-up. Bone mineral density decreased proximally by 19% in both Gruen zones 1 and 7. Bone loss in zones 1, 2, 6, and 7 was significantly associated with stem size. Distally, a small gain in bone mass was found in zones 3 and 5 for medium femoral sizes.

Interpretation We found a marked proximal BMD loss, especially for the larger stems, which may be specific for this particular implant. Long-term studies should reveal whether this proximal bone loss will affect the longevity of the THA.     

Megaprostheses after resection of distal femoral tumors: A rotating hinge design in 30 patients followed for 2-7 years

Between 1981 -1 993, we inserted 32 Kinematic Rotating-Hinge Knee tumor prostheses in 30 patients, of which 2 concerned revisions of the same type of prosthesis. The diagnoses were 21 osteosarcomas, 2 chondrosarcomas, 2 Ewing's sarcomas, 2 metastatic breast carcinomas, l multiple myeloma, l giant cell tumor and 1 Gorham's disease. The median age was 25 (1 2-60) years and the median follow-up for survivors was 3.5 (2-6.6) years. There were 7 metastases and 1 local recurrence.

20 knees had excellent (MSTS) scores for motion (median flexion 1 20°), 8 had good (84O) and 4 had fair (459. The overall function was excellent in 6 cases, good in 14, fair in 9 and poor in 3. The radiographic assessment (ISOLS) gave “excellent” or “good” scores in 27 knees for bone remodelling, 31 for the interface, 28 for anchorage, 31 for the implant body and 30 for the articulation. Extracortical bone bridging greater than 25% was observed in 18 of 27 prostheses.     

反球式全肩关节置换术治疗老年肱骨近端陈旧性骨折

目的:探讨采用反球式全肩关节置换术治疗老年肱骨近端陈旧性骨折的临床疗效。方法:自2012年1月至2017年12月行反球式全肩关节置换术治疗12例老年肱骨近端陈旧性骨折患者,男5例,女7例;年龄63～81岁,平均70.2岁;病程9～18个月,平均12.3个月。采用VAS评分评价肩关节疼痛缓解程度,Constant-Murley评分评价肩关节功能改善情况,统计患者术中及术后并发症。结果:12例全部获得随访,时间15～56个月,平均22.3个月。术后12个月随访时VAS评分(1.9±1.4)分,Constant-Murley评分(83.4±8.4)分;肩关节前屈(92.5±7.7)°,外展(90.4±14.3)°,外旋(31.9±10.0)°,内旋(58.9±13.1)°;术前后差异均有统计学意义(P0.05)。2例发生肩胛盂切迹,影像学表现分别为Ⅰ级和Ⅱ级,随访未发现松动等表现,无病例发生感染、肩峰骨折、假体松动,腋神经损伤等其他并发症。结论:反球式全肩关节置换术治疗老年肱骨近端陈旧性骨折可以获得满意的疗效,但应注意适应证及并发症。     

Mortality after cervical hip fracture: 3002 patients followed for 6 years

In 3002 patients with a femoral intracapsular neck fracture occurring during a 3-year period in the Stockholm area, 79 per cent were admitted from home and the remainder from different types of institutions. The mortality among these fracture patients was higher than in the general population. Patients admitted from institutions had a three to four times higher mortality rate than those coming from home. After 6 years, 54 per cent of the patients admitted from home were still alive compared with only 16 per cent of those admitted from institutions.     

Rehabilitation after femoral neck fracture: 3053 patients followed for 6 years

The rehabilitation of 3053 consecutive patients with femoral neck fractures from Stockholm County was followed up for 6 years. Of the patients 79 per cent were admitted from home. The majority of these patients returned home within 6 months, but patients from the city did so more slowly than patients from rural areas, and with increased secondary rehabilitation measures. Patients treated in general surgical units stayed longer and utilized more secondary rehabilitation resources than those treated in orthopaedic units. At 1 year most differences were equalized.     

Treatment of comminuted proximal humerus fractures with shoulder hemiarthroplasty in elderly patients

This retrospective study was done to find out the outcome of hemiarthroplasty of the shoulder following comminuted proximal humeral fractures in 20 elderly patients. Their average age was 77.6 years. The average follow-up was 33 months. All patients were reviewed in the outpatient clinic using the Constant Score. The median Constant Score was 47.5. None of the patients had severe pain. Four had moderate and 16 had no or mild pain. Range of movement was not good. The activities of daily living were significantly reduced in patients with moderate shoulder pain. Sixteen patients (80%) were satisfied with the outcome of the management of their shoulder injury. Radiological assessment showed malrotation of the prosthesis and ectopic ossification in one patient each. Osteolysis around the greater tuberosity was noted with three isoelastic prostheses. Seven patients showed proximal migration of the prosthesis although there was no significant difference in functional results. Complications included fatal pulmonary embolism in one patient. Overall, hemiarthroplasty of the shoulder gave good pain relief but there was only moderate functional improvement.     

Level of physical activity in elderly patients after hemiarthroplasty for three- and four-part fractures of the proximal humerus

We report on 13 physically active patients who performed sports activities at a weekend or recreational level when they suffered a severe proximal humerus fracture or fracture dislocation. All patients were treated using the NEER II hemiarthroplasty, 9 patients within 4 weeks after trauma and 4 patients 2, 5, 10 and 15 months after trauma. At an average follow-up of 50 (range 6–98) months, all patients were evaluated, both by clinical review and radiographs. Patients obtained 69.0 points using the HSS score (Hospital for Special Surgery) for evaluation. Subjectively, 85% of the patients evaluated the result as ‘good’ or ‘excellent’ on a visual analogue scale for satisfaction. There was no radiographic evidence of implant loosening. At an average period of 33 (range 16–52) weeks 10 patients started with their physical activities again without a change in their participation level. Received: 13 May 1997