Hemiarthroplasty for three- and four- part displaced fractures of the proximal humerus in patients over 65 years of age.

This is a prospective case series, in which the outcome of shoulder hemiarthroplasty in recent three- and four-part fractures of the proximal humerus was evaluated in patients over 65 years of age. From February 1993 to October 2002, 51 patients with 3- or 4-part fractures of the proximal humerus were entered into the study. The criteria for inclusion were age over 65 years and 3- or 4- part displaced fracture. The mean age of the patients was 73 years (range: 65 to 84). The mean follow-up was 5.5 years (range: 2 to 12). According to the Constant-Murley scale, the results were satisfactory or very satisfactory for 74% of the patients. Thirty nine patients (78%) experienced mild or no pain, 50% achieved active anterior elevation greater than 120 degrees, while 40% had active lateral elevation of more than 120 degrees. None of the patients experienced complete recovery of strength and full range of motion. Thirty four patients were able to resume all their daily activities. There were complications in 26% of the patients. Assessment following the Constant-Murley scale demonstrated that two thirds of the patients were pain free and regained a wide range of shoulder movement, while one third resumed their pre-fracture activities to a great extent. The majority of the patients did not recover normal strength.