• Ernst Wiedemann, Ulrich Brunner, Sandra Hauptmann, and Wolf Mutschler.
• Department of Surgery, Klinikum Innenstadt, Munich, Germany. Ernst.Wiedemann@gmx.de.
• Eur J Trauma Emerg S. 2007 Jun 1;33(3):310-22.

ObjectiveReplacement of the fractured humeral head with a modular prosthesis. The procedure aims at an adequate reconstruction of shape and function of the shoulder.IndicationsDisplaced three- and four-part fractures of the proximal humerus that cannot be reduced and internally fixed.ContraindicationsFracture can be reduced and adequately internally fixated. Noncompliant patient.Surgical TechniqueIn beach-chair position, the fractured humeral head is removed via a deltopectoral approach. The Aequalis modular fracture prosthesis can be positioned by two methods: (i) a fracture jig optimizing height and retroversion of the prosthesis, (ii) under additional intraoperative fluoroscopy. Healing of the tuberosities can be promoted by cancellous grafts taken from the fractured head. These are fixed by four heavy sutures running horizontally and two sutures running vertically.Results13 out of 22 patients treated by primary hemiarthroplasty (within 10 days after the fracture) and 34 out of 50 patients treated by secondary arthroplasty could be assessed after a mean follow-up of 40 (15-70) and 44 (8-98) months, respectively. The absolute Constant score amounted to 45 and 50 points, respectively, and the relative score to 56% in both groups. The majority of patients was free of pain or suffered less pain than before the operation (secondary arthroplasty; p < 0.001). In contrast to these, only satisfactory, objective results, self-assessment was good or better than before (secondary prostheses; p < 0.001). In both groups, prognostic factors were the size and position of the tuberosities (p < 0.001).

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