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Predicting Results of Hemiarthroplasty after Shoulder Fracture

Authors: Robinson CM

References: Journal of Bone and Joint Surgery. July 2003. Vol. 85-A. No. 7. Pp. 1215-1223..

Abstract
Treating fractures of the upper arm can be difficult, especially in older adults. Replacing the ball on top of the shoulder is one treatment option. This procedure is called hemiarthroplasty.

Patients get good pain relief with this method, but they may not get the full use of their arm back. Finding ways to tell who will have a good result will help doctors make treatment decisions. This study from Scotland measured the overall survival rate of the replacement part. The authors came up with two models to predict results by looking at all the factors affecting implant success.

One model looks at early results (up to six weeks after injury). The second model looks at results for weeks seven through 12. In both models, age is the most important factor. Older patients (older than 70 years) have the poorest outcome.

Other factors in the early period have to do with the patient. These include tobacco and alcohol use and if there is nerve injury. Surgery-related factors are more telling in the long-term results. In both groups, factors to consider include the patient's level of motivation, the effect of physical therapy, and whether there are other injuries in the shoulder. A longer study with more patients is needed to look at these variables.

The authors think there are ways to tell who would be right for a hemiarthroplasty operation after severe shoulder fracture. Younger, motivated patients in good health and with good mental ability have the best results.

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