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    Factors affecting results of patients with humeral proximal end fractures undergoing primary hemiarthroplasty: A retrospective study in 42 patients
    (Elsevier Sci Ltd, 2009) Esen, Erdinc; Dogramaci, Yunus; Gultekin, Serap; Deveci, Mehmet Ali; Suluova, Fatih; Kanatli, Ulunay; Bolukbasi, Selcuk
    Aim: Our study reports long-term results and factors related to patient satisfaction in the case of primary hemiarthroplasty for humeral proximal end fractures. Patients and methods: We retrospectively evaluated 42 patients with humeral proximal end fractures who underwent primary hemiarthroplasty in our clinic from February 1994 to March 2004. Of the 42 patients, 14 (33%) were male and 28 (67%) female. The mean age was 68.9 +/- 5.57 years (age range: 59-81 years). The mean follow-up period was 78.8 +/- 26.6 months (range: 48-118 months). We evaluated the following parameters: fracture type according to the Neer classification, the time interval between the fracture and the operation, postoperative radiological examination, the Neer outcome assessment criteria for patient satisfaction and functions, according to the Constant and Murley Scoring (CMS) system. Results: We found good-to-excel lent outcomes in 36 (85.7%) and poor outcome in six (14.3%) patients according to the Neer criteria. The average values for CMS score, anterior elevation and external rotation were 73.59 +/- 17.95 (25-94), 121.30 +/- 42.99 degrees (range: 30-170 degrees) and 30 degrees (range: 0-80 degrees), respectively. The patients who had been operated in the early period (within 2 weeks) had better functional outcomes (p < 0.001) and had significant pain relief. There was a strong positive correlation between the humeral offset (distance between the head and the tuberosities) and the degree of elevation (r = 0.872, p < 0.001). There was a strong negative correlation between the height of the humeral head and the degree of elevation (r = -0.853, p < 0.001). Conclusion: In humeral proximal end fractures, primary hemiarthroplasty in the early period with the anatomic reconstruction of bone and soft tissues of the shoulder joint and long-term regular rehabilitation programme are important factors contributing to increased patient satisfaction. (C) 2009 Elsevier Ltd. All rights reserved.