Session VIII - Upper Extremity

Functional Outcome and General Health Status following Hemiarthoplasty for Proximal Humeral Fractures

Michael McKee, MD, FRCS(C); Tammy Znajda; Hans J. Kreder, MD FRCS (C); Emil H. Schemitsch, MD, FRCS (C); David J.G. Stephen, MD, FRCS (C); Daniel Yoo, BSc; St. Michael's Hospital, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON

We reviewed forty consecutive patients who had undergone shoulder hemiarthroplasty for proximal humeral fracture to determine quality of life as measured by both upper extremity specific measures and the SF-36 health status questionnaire. All patients had sustained three- or four-part fractures or fracture-dislocations of the humeral head (OTA type 11B, 11C) following falls, motor vehicle accidents or seizures. Eight patients had died, three were lost to follow-up and twenty-nine were reviewed. At the latest follow-up available, all eight patients who died had been doing well and none required further surgical procedures. There were 20 women and 9 men with a mean age of 71.0 years (range 31 to 87 years). All twenty-nine completed the SF-36 health status survey and four upper-extremity-specific questionnaires (Shoulder Pain and Disability Index -SPADI, Subjective Shoulder Rating Scale - SSRS, Simple Shoulder Test - SST, Shoulder Severity Index - SSI).The mean follow-up was 37.5 months with a range from 6 to 75 months. The only significant surgical complication was recurrent anterior subluxation (treated conservatively) in two patients. Patients demonstrated significant impairment on both upper extremity specific scores and certain components of the SF-36 scores. The mean SPADI score was 47.5, the mean SSRS 59.0, the mean SST 32.2, and the mean SSI was 52.8. Components of the SF-36 which showed significant decreases compared to age- and sex-matched normative data included physical functioning: 48.4, role-physical: 36.6, energy level: 55.0, pain: 62.3 and "average" score: 61.1. The shoulder-specific scores correlated well with the pain and "physical" component scores of the SF-36 (p=0.02). Patients followed for more than fourteen months did not have improved scores on either upper extremity specific or general health status scores relative to those patients fourteen months or less since their injury. Despite technical and radiographic success and a low complication rate, patients who had undergone shoulder hemiarthroplasty for fracture demonstrated significant deficits in both upper-extremity-specific scores and in numerous categories of the SF-36 general health status questionnaire when compared to age- and sex-matched controls. Results do not tend to improve with time.