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Shoulder Arthroplasty for Proximal Humeral Nonunions

Shoulder Arthroplasty for Proximal Humeral Nonunions

Shoulder fractures are common injuries among the elderly, but the management of these fractures can be challenging for physicians. Treatment options include nonoperative modalities, osteosynthesis, and arthroplasty, but patients can still suffer from substantial pain and functional impairment even after receiving these interventions. Nonunions have been frequently linked to bone loss, poor bone quality, and soft-tissue contractures. “In previous studies, surgeons have had difficulty achieving fracture union with internal fixation and bone-grafting treatments in patients with proximal humeral fracture nonunions,” explains Thomas R. Duquin, MD. “As an alternative, unconstrained shoulder arthroplasty has been advocated for treating these nonunions. Unfortunately, research has documented high rates of unsatisfactory results with arthroplasty, especially with regard to functional outcomes.” Study Results on Proximal Humeral Nonunions In the Journal of Bone and Joint Surgery, Dr. Duquin and colleagues recently had a study published that reviewed the results and complications of conventional anatomic shoulder arthroplasty for proximal humeral nonunions. The study also identified factors associated with success or failure. From 1976 to 2007, 67 patients who underwent unconstrained shoulder arthroplasty for proximal humeral nonunions were followed for more than 2 years. The study included 49 women and 18 men with an average age of 64 and a mean duration of 9 years follow-up. Fracture type was assessed according to the Neer rating classification. There were two-part fractures in 36 patients, three-part fractures in 16 patients, and four-part fractures in 15 patients. Hemiarthroplasty was performed in 54 individuals, and total shoulder arthroplasty was done in 13. According to findings, there were 33 excellent or satisfactory results based on a modified Neer rating classification (Figure 1). “For...
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