An Unusual Disengagement of the Humeral Head Component After Hemiarthroplasty: A Case Report Presentation

Overview

Journal J Orthop Case Rep

Specialty Orthopedics

Date 2016 Jun 15

PMID 27298964

Authors

Cuneyd Gunay

Fuad Oken

Ahmet Ozgur Yildirim

Ahmet Ucaner

Affiliations

Soon will be listed here.

Abstract

Introduction: Proximal humeral fractures account for 4% to 5% of all fractures. Complex proximal humeral fractures with displaced three- and four-part fragments, humeral head splits and fracture-dislocations are more difficult to treat. In older patients, because of poor bone quality, hemiarthroplasty is often the indicated treatment.

Case Report: One such case of a 73-year-old woman is presented here. The patient presented with a four-part fracture of the proximal humerus, with displacement of the humeral head. Hemiarthroplasty was done in the right shoulder. At postoperative 20 days, during physical therapy, the humeral head component of the prosthesis disengaged and a second operation was necessary. A deltopectoral approach was repeated using the previous incision. The humeral stem was seen to be well-fixed into the bone so the humeral head was changed for a new one of the same size. At two years, the dominant right side had active, painless ROM.

Conclusion: The management and two-year follow-up of this case is reported here, which was the first to occur at our institution.

References

Wijgman A, Roolker W, Patt T, Raaymakers E, Marti R . Open reduction and internal fixation of three and four-part fractures of the proximal part of the humerus. J Bone Joint Surg Am. 2002; 84(11):1919-25. View

Nordqvist A, Petersson C . Incidence and causes of shoulder girdle injuries in an urban population. J Shoulder Elbow Surg. 1995; 4(2):107-12. DOI: 10.1016/s1058-2746(05)80063-1. View

Solberg B, Moon C, Franco D, Paiement G . Surgical treatment of three and four-part proximal humeral fractures. J Bone Joint Surg Am. 2009; 91(7):1689-97. DOI: 10.2106/JBJS.H.00133. View

Krishnan S, Bennion P, Reineck J, Burkhead W . Hemiarthroplasty for proximal humeral fracture: restoration of the Gothic arch. Orthop Clin North Am. 2008; 39(4):441-50, vi. DOI: 10.1016/j.ocl.2008.05.004. View

Green A, Barnard W, Limbird R . Humeral head replacement for acute, four-part proximal humerus fractures. J Shoulder Elbow Surg. 2012; 2(5):249-54. DOI: 10.1016/S1058-2746(09)80084-0. View

Lanting B, MacDermid J, Drosdowech D, Faber K . Proximal humeral fractures: a systematic review of treatment modalities. J Shoulder Elbow Surg. 2008; 17(1):42-54. DOI: 10.1016/j.jse.2007.03.016. View

Robinson C, Page R, Hill R, Sanders D, Court-Brown C, Wakefield A . Primary hemiarthroplasty for treatment of proximal humeral fractures. J Bone Joint Surg Am. 2003; 85(7):1215-23. DOI: 10.2106/00004623-200307000-00006. View

Gamradt S, Gelber J, Zhang A . Shoulder function and pain level after revision of failed reverse shoulder replacement to hemiarthroplasty. Int J Shoulder Surg. 2012; 6(2):29-35. PMC: 3391782. DOI: 10.4103/0973-6042.96991. View

Hempfing A, Leunig M, Ballmer F, Hertel R . Surgical landmarks to determine humeral head retrotorsion for hemiarthroplasty in fractures. J Shoulder Elbow Surg. 2001; 10(5):460-3. DOI: 10.1067/mse.2001.117127. View

10.

Anjum S, Butt M . Treatment of comminuted proximal humerus fractures with shoulder hemiarthroplasty in elderly patients. Acta Orthop Belg. 2005; 71(4):388-95. View

11.

Boileau P, Krishnan S, Tinsi L, Walch G, Coste J, Mole D . Tuberosity malposition and migration: reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus. J Shoulder Elbow Surg. 2002; 11(5):401-12. DOI: 10.1067/mse.2002.124527. View

12.

Neer 2nd C . Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am. 1970; 52(6):1077-89. View

13.

Plausinis D, Kwon Y, Zuckerman J . Complications of humeral head replacement for proximal humeral fractures. Instr Course Lect. 2005; 54:371-80. View

14.

Jakob R, Miniaci A, Anson P, Jaberg H, Osterwalder A, Ganz R . Four-part valgus impacted fractures of the proximal humerus. J Bone Joint Surg Br. 1991; 73(2):295-8. DOI: 10.1302/0301-620X.73B2.2005159. View

15.

Sirveaux F, Roche O, Mole D . Shoulder arthroplasty for acute proximal humerus fracture. Orthop Traumatol Surg Res. 2010; 96(6):683-94. DOI: 10.1016/j.otsr.2010.07.001. View

16.

Vallier H . Treatment of proximal humerus fractures. J Orthop Trauma. 2007; 21(7):469-76. DOI: 10.1097/BOT.0b013e318133479c. View