Hemiarthroplasty for Proximal Humerus Fracture

Patient Selection

Patient Factors

  • Low demand
  • Over 75 years unless very fit
  • Females > Males (osteoporotic bone)

Fracture Factors

  • Head split fractures
  • Delayed fracture dislocations

  • 20 degrees of initial varus malalignment and if anatomical reduction of the medial hinge cannot be achieved intra-operatively

Salvage

  • For failed ORIF, AVN, non-union, or malunion

Factors that Result in a Good Hemiarthroplasty

Tuberosity Reduction and Healing

  • GT should be 10 – 15 mm from the top of the prosthesis
  • Reduce tuberosities to where they sit comfortably, then adjust head height
  • Use humeral head bone graft under and around tuberosities
  • Suture tuberosities to each other, around stem and around shaft
  • Consider XR to confirm position

Humeral Head Height

  • Do not leave the humeral head too proud – results in tuberosity detachment
  • Do not leave it too short – alters mechanics of cuff and renders it useless
  • Top of pec major tendon should be 5.6 cm below top of head
  • Tuberosity should be 10-15 mm below top of head

Humeral Head Version

  • Normal version is between 15 – 30 degrees
  • Common mistake is excessive retroversion resulting in posterior instability
  • Reference of transepicondylar axis
  • Aim for 20-30 degrees
  • Can use bicipital groove as reference point – lateral fin of a 3-fin prosthesis will generally lie 30 degrees posterior to the posterior margin of the biceps groove

Complications

  • Dislocation
  • Glenoid erosion
  • Iatrogenic fracture
  • Tuberosity non-union or malunion
  • Poor cuff function (pre-existing cuff disease)

Outcomes

  • Best results if done early (<2 weeks)
  • If done as the primary procedure (i.e., not salvage)
  • If tuberosities heal in anatomic position
  • Expect 90 degrees abduction, 30 degrees ER, and 100 degrees FF
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