ACTA FAC MED NAISS 2008; 25 (1): 47-53

Professional article

SHOULDER ARTHROPLASTY FOR FRACTURES AND SIGNIFICANCE OF EARLY REHABILITATION 

Vladimir Vukov ¹,
Marko Zdravkovic ¹,
Tatjana Radovanovic²,
Mirjana Manojlovic-Opacic²

¹ Institute of Orthopedic Surgeryand Traumatology, Clinical Center of Serbia, Belgrade

2 Center for Physical Therapy and Rehabilitation, Clinical Center of Serbia, Belgrade

SUMMARY

 One of the bone-joint injuries, which if operatively untreated often causes invalidity, can be a multifragmented, dislocated fracture (three- and four-part) of the upper end of the humerus. The attitude of Department of Shoulder Surgery (at the Institute of Orthopedic Surgery and Traumatology, CCS in Belgrade) is that all proximal humeral fractures should be surgically treated, except those with tolerable dislocation, or because of contraindications for other reasons.

Three- and four-part fractures with significant dislocations of fragments, fractures complicated with head dislocation, and patients over 60 years of age are treated by implanting partial shoulder prosthesis - with haemiarthroplasty. 

Since 1985, over 700 patients with fractures on the upper end of humerus have been operated on. Over 180 of these were three-part and four-part fractures.  Around 30% of these fractures were complicated with humeral head dislocation. Apart from acute fractures, there were about 5% of chronic cases with proximal humerus pseudoarthroses or avascular necroses of the humeral head.

In 64 patients, these fractures were treated with shoulder hemiarthroplasty. In others we used osteosynthesis with a wire-loop, “T” plate, “L” plate, or a combination of the plate and wire. We conducted the first shoulder hemiarthroplasty in 1989.

In this paper, we discussed our 16-year-long experience in the use of partial prosthesis with multifragmented shoulder fractures. We will explain the significance of precise reconstruction and firm fixation of both tuberosities, the significance of proper positioning of the prosthesis, as well as the type or shape of the prosthesis. We consider a new approach of early rehabilitation program to be very significant for attaining the maximal functional restitution of the shoulder.

Key words: fiber types, rat skeletal muscle, mATPase histochemistry, ammonium sulfide, cationic dyes