Fracture sequelae in an active woman.

An active woman in her mid 60's presented with pain and loss of function of her left shoulder resulting from a proximal humeral fracture sustained in a bike crash twenty years prior. Her preoperative x-rays show a malunited proximal humeral fracture with humeral head articular surface irregularity and subchondral bone resorption.

Because of her active lifestyle, she elected a hemiarthroplasty with a posteriorly eccentric humeral head and an impaction grafted standard smooth stem. No glenoid arthroplasty was needed. The rotator cuff was essentially intact.

Seven years after surgery at the age of 73 she returned for routine followup with full comfortable motion and function. Her activities ranged from playing piano and flute to swimming, shot put and discus. Her postoperative films show a securely fixed humeral stem without evidence of stress shielding, a well centered humeral head, and substantial radiographic joint space.

Her active elevation is shown below.

Comment:  This case demonstrates the value of a conservative hemiarthroplasty in a highly motivated patient.

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Here are some videos that are of shoulder interest

Shoulder arthritis - what you need to know (see this link).

How to x-ray the shoulder (see this link).

The ream and run procedure (see this link).

The total shoulder arthroplasty (see this link).

The cuff tear arthropathy arthroplasty (see this link).

The reverse total shoulder arthroplasty (see this link).

The smooth and move procedure for irreparable rotator cuff tears (see this link).

Shoulder rehabilitation exercises (see this link).