Shoulder Arthroplasty for Fracture: Does a Fracture-specific Stem Make a Difference?

Background Arthroplasty for shoulder fractures is a technically challenging and unpredictable procedure and its use is controversial.

Questions/purposes We therefore asked (1) to what degree function would be restored, (2) whether tuberosity healing would reliably occur, and (3) whether stem design would influence function in patients treated with hemiarthroplasty for proximal humerus fracture.

Patients and Methods We retrospectively reviewed all patients treated with a hemiarthroplasty for proximal humeral fracture between September 2001 and May 2006. The first 58 patients (September 2001 to March 2004) were treated with a conventional humeral prosthesis. The next 112 patients (April 2004 to May 2006) were treated with a fracture-specific humeral prosthesis. Clinical measures (American Shoulder and Elbow Surgeons scores, visual analog pain scores, and goniometric measurements of glenohumeral motion) and radiographic evaluation of tuberosity healing were performed at minimum 24-month followup (mean, 32 months; range, 24-96 months).

Results Mean active anterior elevation was 118°, mean active external rotation 37.6°, and mean American Shoulder and Elbow Surgeons score 66. Overall, 127 of 170 (75%) greater tuberosities healed. With respect to stem design, active anterior elevation, active external rotation, and American Shoulder and Elbow Surgeons score were better with fracture-specific stems (129.8°, 39°, and 72, respectively) than with conventional stems (95.4°, 33.0°, and 55, respectively). Fewer tuberosities healed with conventional stems (38 of 58, 66%) than with fracture-specific stems (89 of 112, 79%).

Conclusions The use of fracture-specific stems during proximal humeral hemiarthroplasty for fracture appears to improve functional use of the injured shoulder and tuberosity healing compared to conventional stems.

Level of Evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.