• F Reuther, G Kohut, and S Nijs.
• Klinik für Unfallchirurgie und Orthopädie, DRK Kliniken Berlin| Köpenick, Salvador-Allende-Str. 2-8, 12559, Berlin, Deutschland, f.reuther@drk-kliniken-berlin.de.
• Oper Orthop Traumatol. 2014 Aug 1;26(4):369-82; quiz 382-4.

ObjectivePrimary endoprosthetic joint replacement in non-reconstructable proximal humeral fracture in the elderly. Alternative to fracture hemi-endoprosthesis with resorption of tuberosities and secondary rotator cuff insuffiency which leads to unsatisfying functional results.IndicationsNon-reconstructable proximal humeral fracture in mainly old patients with osteoporotic bone, multifragment tuberosity fracture and degenerative rotator cuff lesion.ContraindicationsPatient not fit for surgery, pre-existing shoulder infection or sepsis, severe general medical condition, nerve damage (axillay nerve, Plexus)Surgical TechniqueDeltopectoral or delta-split approach. Removal of head fragments. Reinforcement of tuberosities and exposure of glenoid. Implantation of the metaglene and fixation of glenosphere after removal of labrum and capsule. Reaming of humeral shaft and cementing of the prosthesis stem. The retroversion and height of the reverse central part then can be adjusted freely. The tuberosities can be fixed with suture at the middle part. With a titanium cable an additional compression osteosynthesis of the tuberosities can be done by direct pressing on the osseoinductive coated central part.Postoperative ManagementPositioning of the arm on an abduction pillow for 4 weeks, then active exercise treatment until week 6. Free movement exercise under guidance for 6 months.ResultsMulticentre study with 43 patients (40 women, 3 men), average age 79.8 years (range 66.9-95.8 years), 36 patients with 4-part-fracture according to Neer classification. To date, follow-up of 24 patients after at least 24 months, 9 patients lost to follow-up. Mean Constant Score 65.5 points, age and gender corrected Constant Score 96.7 %. Visual Analog Scale (VAS) for pain 1.9. VAS for subjective satisfaction 7.5. Mean American Shoulder and Elbow Surgeons Shoulder Score (ASES) 72.8 points. Mean active range of motion: flexion 142.3°, abduction 135.9°, external rotation 18.6°, internal rotation 47°, the radiological evaluation so far did not show any signs of scapular notching.ComplicationsOne dislocated acromion fracture.

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