Objective: Conservative treatment is indicated for a proximal humeral fracture without displacement. It is difficult to maintain conservative treatment for some elderly patients because of spinal deformities and different levels of cognitive understanding. Usually, conservative treatment is indicated for elderly patients because of other co-morbidities. When fracture displacement is identified, it is not always possible to change the treatment plan because of the patients' underlying general conditions, which can lead to nonunion of proximal humeral fractures.
Methods: We analyzed three patient cases including one male and two females, with an average age of 86.5 years. We evaluated the waiting time until operation, Japan Orthopedic Association (JOA) score and radiographic studies.
Results: One patient waited 1 year, another waited 2 years and another waiting time was unknown. The preoperative JOA score for pain was 5, for function it was 1.7, and for range of motion it was 4.3; the postoperative JOA score for pain was 23.3, for function it was 3.3, and for range of motion it was 10.3, respectively. We found the union of the greater tuberosity in one case on a follow-up postoperative radiograph.
Conclusion: Hemiarthroplasty for nonunion of proximal humeral fractures can relieve a patient's pain and improve their quality of life. Shoulder function depends on the tuberosities. Our cases could not establish complete union of the tuberosities, such that their shoulder functions were not improved. In order to get tuberosity union, it is important to improve intraoperative methods including a change of the implant.