The principle is then to replace the humeral head with a portion of metal sphere, in elderly patients or in case of supposed major risk of necrosis of the humeral head.
Like prostheses for osteoarthritis (see dedicated chapter) there are several possibilities and assemblies:
The principle is then to replace the humeral head with a portion of metal sphere, in elderly patients or in case of supposed major risk of necrosis of the humeral head.
Like prostheses for osteoarthritis (see dedicated chapter) there are several possibilities and assemblies:
Total prosthesis (humerus and glenoid)This type of prosthesis is reserved for very old patients, in case of associated shoulder osteoarthritis or even in the presence of a rotator cuff broken and / or non-functional (advanced fatty muscle degeneration). A total anatomic prosthesis with tuberosity reconstruction is theoretically logical if the cuff seems healthy, but generally few teams practice choosing a hemi-prosthesis or an inverted prosthesis for fracture.
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The total inverted prosthesis in complex fractures of the upper end of the humerus has been a frequent indication for about ten years, mainly in geronto-traumatology.In fact, the anatomic hemi-prostheses with reconstruction of the tuberosities are technically difficult and the functional result is frequently average or even bad in the old subject. Setting up an inverted prosthesis presents less technical difficulties, regularly gives good results at least on pain and function for basic daily life (hand to mouth essentially) and without rebuilding the tuberosities ++++ On the other hand, if one wishes to optimize the functional results, it requires reconstructing and consolidating the tuberosities around the inverted prosthesis. The conservation of the tuberosities increases the possiblity of rotation (external especially) and thus makes it possible to bring the hand on the top of the head (to comb oneself, to wash the hair, to shave, to bring the hand in the back etc …) |
