ACUTE PROSTHETIC REPLACEMENT FOR SEVERE FRACTURES OF THE PROXIMAL HUMERUS

Nineteen patients with 20 severe proximal humeral fractures were treat ed early with a Neer humeral prosthesis from 1979 to 1986. There were 18 four-part and two three-part fractures. The average age of the pati ents at the time of injury was 64 years. Follow-up evaluation was perf ormed at an average of 40 months. Pain relief was satisfactory in 18 o f 20 fractures. Patients were satisfied with the result in 16 of the 2 0 shoulders. Functional evaluation was good or fair in 15 of 20 patien ts. Active forward elevation averaged 72-degrees and active external r otation 16-degrees. Complications consisted of one axillary nerve pals y, one postoperative posterior dislocation, loosening of one uncemente d humeral prosthesis, and one breakage of fixation wire requiring subs equent removal. Patients who could not comply with the postoperative r ehabilitation program had poor results. Poor function appeared to be d irectly related to lack of rotator cuff integrity. Surgical techniques designed to securing tuberosity union are essential.