Original Research Article
Year: 2019 | Month: April-June | Volume: 4 | Issue: 2 | Pages: 91-106
Results of Hemiarthroplasty in Comminuted Proximal Humerus Fracture in Elderly
Dr. Alok Sobhan Datta1, Dr. S. Adhikary2
1Associate Professor, Department of Orthopaedics, IPGME&R, SSKM Hospitla Kolkata.
2Post Graduate Trainee, Department of Orthopaedics, IPGME&R, SSKM Hospitla Kolkata.
Corresponding Author: Dr. Alok Sobhan Datta
ABSTRACT
We evaluated the outcome of hemiarthroplasty in the management of comminuted proximal humerus fractures in 21 elderly patient (60 years and above).
Preoperative clinical & radiological assessment was done in all patients. There was female preponderance (61.9%female, 38.1% male). Left side was affected in 13 cases where as right side was affected in 8 cases. The female: male ratio in our series was 1:0.62. Patient’s average age at operation was 68.9 years (61-78 years). The average period of follow up was 12.4 months (6-18 months).
Majority of the patients had medical comorbidities (total 10 incidence of hypertension, three cases of diabetes and 3 cases of hypothyroidism) which increase the fracture operation interval. Majority of the patient (61.9%) were operated in the second week. Only three patients were operated in after 2 weeks.
In our series 61.9% patients were discharged within the first week. Only two patients needed hospital stay more than two weeks. We followed up 61.9% patients for 7-12 months and 28.6% for 13-18 months & the average period of follow up was 12.4months (6-18 months) .
Two patients suffered from superficial infection which healed after two weeks. There were no other complications. No patient required revision surgery.
Average forward flexion was 28.8° at 1 month and 74.5° at 6 months, average abduction was 33.3° at 1 month and 80.5° at 6 months. Average Constant-Murley score was improved from 24.1° at 1 month to 47.1° at 6 months. Pre operative VAS score was 8.5 which become 4.7 at 1 month (44.7% reduction) and 2.5 at 6 months (70.6% reduction). This improvement in functional outcome (forward flexion, abduction, Constant-Murley score) and pain relief from 1 month to 6 months was statistically significant.
In our study, outcome is better at 6 month in patients aged below 70 years. Average forward flexion, abduction, VAS and Constant Murley score at 6 months in the <70 years age group were 82.7°,88.1°,1.9,and 50 respectively in comparison to 61.2° ,68.1° ,3.5 and 42.5 in the age group of 70 years and above. Statistical analysis shows the difference to be statistically significant.
After considering all the results & values we divided our outcome in 3 categories- good, fair & poor. We got 47.6 % good result & 42.9 % fair result and 9.5% poor results.
Most of the studies in this field showed that, hemiarthroplasty shoulder in elderly patients provides good pain relief but functional outcome and range of movements was not satisfactory which is corroborative with our findings. Our limitation was small sample size with short follow up period. So, longer study with large number of patients is needed to explore the benefits and pitfalls of hemiarthroplasty of shoulder.
Key words: hemiarthroplasty, comminuted proximal humerus fractures, elderly.