Arthroscopic capsular release after hemiarthroplasty of the shoulder for fracture: a new treatment paradigm.

Abstract

Four-part fracture of the proximal humerus is often an indication for hemiarthroplasty. Anatomic healing of the tuberosities is required to recover full range of motion. The authors describe their philosophy of postoperative care, which is different from the conventional wisdom. The patient is immobilized in a sling for 6 weeks until healing of the tuberosities is strong enough that motion of the shoulder will not cause the fracture fragments to displace. By prioritizing bone healing as more important than early motion, there is a possibility that arthrofibrosis may develop. However, arthroscopic release and lysis of adhesions provides a safe and reliable means to regain motion after the bone has healed. Because anatomic healing of the tuberosities is so critical to function after these fractures, we see no reason to jeopardize bone healing with ill-advised early motion because motion can virtually always be restored by means of a secondary capsular release.