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Hemiarthroplasty to Manage Proximal Humerus Fractures
Shoulder hemiarthroplasty is primarily indicated for the management of three- and four-part proximal humerus fractures; fracture-dislocations of the proximal humerus in older patients with osteoporosis, chronic anterior or posterior dislocation of the humeral head with involvement of more than 40% of the articular surface; and head-splitting articular segment fractures. Less commonly, hemiarthroplasty may be indicated for some younger patients with fracture patterns that cannot be feasibly reduced with internal fixation. Clinical studies of hemiarthroplasty in patients with proximal humerus fractures are often difficult to compare because of the heterogeneity of fracture patterns, rehabilitation protocols, surgical techniques, implant designs, and functional outcome measurements. Given these limitations, results show that hemiarthroplasty provides pain relief with varying levels of shoulder function. This chapter reviews the indications, contraindications, results, and techniques for hemiarthroplasty in the management of proximal humerus fractures. Postoperative protocols and tips for avoiding complications are also presented.