Prosthetic arthroplasty for fractures and fracture-dislocations of the proximal humerus.

During the period from 1970 through 1979, proximal humeral arthroplasty with prostheses of the Neer design was performed in 49 shoulders (48 patients) with complex acute or chronic fractures and fracture-dislocations of the proximal humerus. Follow-up evaluation included physical and roentgenographic examination at least two years after surgery for 43 of the 48 patients and averaged 38 months (range, 2-10 years). Of the 43 patients with adequate follow-up evaluation, 16 had acute and 27 (1 bilateral) had chronic fracture problems. Pain relief was satisfactory in all of the 16 shoulders with acute fractures and in 25 of the 28 shoulders with chronic fracture problems. Active abduction averaged 101 degrees in the acute fracture group (range, 35 degrees-160 degrees) and 112 degrees in the chronic fracture group (range, 20 degrees-180 degrees). Complications in shoulders with acute fractures were associated with problems in tuberosity and rotator cuff healing. Complications were more frequent in shoulders with chronic fractures and fracture-dislocations, and were generally related to surgical difficulty, extensive tissue scarring, and distortion of anatomy. The Neer prosthesis affords satisfactory pain relief for both acute and chronic complex fracture-dislocations of the proximal humerus, but the return of function is governed by the security of tuberosity-muscle cuff repair, sufficient protection after operation, and long-term physiotherapy. If possible, surgery should be performed early to avoid the scarring and inelasticity that engender complications and limit functional recovery in shoulders with chronic fractures.