Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-06-2012 | Trauma Surgery

Suture fixation versus cable cerclage of the tuberosities in shoulder arthroplasty-clinical and radiologic results

Authors: Sven-Oliver Dietz, Paul Broos, Stefaan Nijs

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 6/2012

Abstract

Background

The most important individual parameter linked to functional outcome following hemiarthroplasty for fractures of the proximal humerus is anatomical healing of the tuberosities. The aim of our study was to evaluate whether the fixation method influences tuberosity healing and functional outcome.

Methods

Twenty-five consecutive patients with acute 4-part fractures of the proximal humerus were treated with hemiarthroplasty and cable fixation of the tuberosities. Twenty-nine previous patients with four-part fractures treated with hemiarthroplasty and suture fixation of the tuberosities were included as a control group. Functional evaluation was measured with the Constant Score 1 year after the operation. Radiographic evaluation included evaluation of the extent of tuberosity healing and head centralisation.

Results

The average Constant Score was 53.2 points in the suture group and 60.9 in the cable group (p = 0.29). An x-ray evaluation revealed that 40% of the tuberosities in the suture group were anatomically healed versus 75% (p = 0.027) in the cable group. In the suture group, 44% of the prostheses showed marked superior migration, whereas 25% of the prostheses in the cable group showed such migration (p = 0.027).

Conclusion

In our collective adding an encircling steel cable for the fixation of the tuberosities resulted in higher anatomical healing rates.

Neer CS 2nd (1970) Displaced proximal humeral fractures. II. Treatment of three-part and four-part displacement. J Bone Joint Surg Am 52(6):1090–1103PubMed

Kralinger F, Schwaiger R, Wambacher M, Farrell E, Menth-Chiari W, Lajtai G, Hubner C, Resch H (2004) Outcome after primary hemiarthroplasty for fracture of the head of the humerus. A retrospective multicentre study of 167 patients. J Bone Joint Surg Br 86(2):217–219. doi:10.1302/0301-620X.86B2.14553 PubMedCrossRef

Mighell MA, Kolm GP, Collinge CA, Frankle MA (2003) Outcomes of hemiarthroplasty for fractures of the proximal humerus. J Shoulder Elbow Surg 12(6):569–577. doi:10.1016/S1058274603002131 PubMedCrossRef

Robinson CM, Page RS, Hill RM, Sanders DL, Court-Brown CM, Wakefield AE (2003) Primary hemiarthroplasty for treatment of proximal humeral fractures. J Bone Joint Surg Am 85-A(7):1215–1223PubMed

Boileau P, Krishnan SG, Tinsi L, Walch G, Coste JS, Mole D (2002) Tuberosity malposition and migration: reasons for poor outcomes after hemiarthroplasty for displaced fractures of the proximal humerus. J Shoulder Elbow Surg 11(5):401–412. doi:10.1067/mse.2002.124527 PubMedCrossRef

Loew M, Heitkemper S, Parsch D, Schneider S, Rickert M (2006) Influence of the design of the prosthesis on the outcome after hemiarthroplasty of the shoulder in displaced fractures of the head of the humerus. J Bone Joint Surg Br 88(3):345–350. doi:10.1302/0301-620X.88B3.16909 PubMedCrossRef

Frankle MA, Ondrovic LE, Markee BA, Harris ML, Lee WE 3rd (2002) Stability of tuberosity reattachment in proximal humeral hemiarthroplasty. J Shoulder Elbow Surg 11(5):413–420. doi:10.1067/mse.2002.126098 PubMedCrossRef

Krause FG, Huebschle L, Hertel R (2007) Reattachment of the tuberosities with cable wires and bone graft in hemiarthroplasties done for proximal humeral fractures with cable wire and bone graft: 58 patients with a 22-month minimum follow-up. J Orthop Trauma 21(10):682–686. doi:10.1097/BOT.0b013e31815917e0 PubMedCrossRef

Neer CS 2nd (1970) Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am 52(6):1077–1089PubMed

10.

Greiner SH, Diederichs G, Kroning I, Scheibel M, Perka C (2009) Tuberosity position correlates with fatty infiltration of the rotator cuff after hemiarthroplasty for proximal humeral fractures. J Shoulder Elbow Surg 18(3):431–436. doi:10.1016/j.jse.2008.10.007 PubMedCrossRef

11.

Konrad GG, Mehlhorn A, Kuhle J, Strohm PC, Sudkamp NP (2008) Proximal humerus fractures—current treatment options. Acta Chir Orthop Traumatol Cech 75(6):413–421PubMed

12.

Boileau P, Caligaris-Cordero B, Payeur F, Tinsi L, Argenson C (1999) Prognostic factors during rehabilitation after shoulder prostheses for fracture. Rev Chir Orthop Reparatrice Appar Mot 85(2):106–116PubMed

13.

Demirhan M, Akpinar S, Atalar AC, Akman S, Akalin Y (1998) Primary replacement of the humeral head in iatrogenically displaced fracture-dislocations of the shoulder: a report about six cases. Injury 29(7):525–528PubMedCrossRef

14.

Frankle MA, Greenwald DP, Markee BA, Ondrovic LE, Lee WE 3rd (2001) Biomechanical effects of malposition of tuberosity fragments on the humeral prosthetic reconstruction for four-part proximal humerus fractures. J Shoulder Elbow Surg 10(4):321–326. doi:10.1067/mse.2001.113962 PubMedCrossRef

15.

Fialka C, Stampfl P, Arbes S, Reuter P, Oberleitner G, Vecsei V (2008) Primary hemiarthroplasty in four-part fractures of the proximal humerus: randomized trial of two different implant systems. J Shoulder Elbow Surg 17(2):210–215. doi:10.1016/j.jse.2007.07.002 PubMedCrossRef

16.

Bufquin T, Hersan A, Hubert L, Massin P (2007) Reverse shoulder arthroplasty for the treatment of three- and four-part fractures of the proximal humerus in the elderly: a prospective review of 43 cases with a short-term follow-up. J Bone Joint Surg Br 89(4):516–520. doi:10.1302/0301-620X.89B4.18435 PubMedCrossRef

17.

Cazeneuve JF, Cristofari DJ (2006) Grammont reversed prosthesis for acute complex fracture of the proximal humerus in an elderly population with 5 to 12 years follow-up. Rev Chir Orthop Reparatrice Appar Mot 92(6):543–548PubMedCrossRef

18.

Wall B, Walch G (2007) Reverse shoulder arthroplasty for the treatment of proximal humeral fractures. Hand Clin 23 (4):425-430, v-vi. doi:10.1016/j.hcl.2007.08.002

19.

Nijs S, Lerut P, Broos P The non-reconstructable proximal humerus fracture: reversed or anatomical arthroplasty? In: Supplement: 7th European Trauma Congress, Ljubljana, 2006. p 222

20.

Hettrich CM, Boraiah S, Dyke JP, Neviaser A, Helfet DL, Lorich DG (2010) Quantitative assessment of the vascularity of the proximal part of the humerus. J Bone Joint Surg Am 92(4):943–948. doi:10.2106/JBJS.H.01144 PubMedCrossRef

Title: Suture fixation versus cable cerclage of the tuberosities in shoulder arthroplasty-clinical and radiologic results
Authors: Sven-Oliver Dietz
Paul Broos
Stefaan Nijs
Publication date: 01-06-2012
Publisher: Springer-Verlag
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 6/2012
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-012-1470-2

At a glance: The STEP trials

Springer Medicine

Suture fixation versus cable cerclage of the tuberosities in shoulder arthroplasty-clinical and radiologic results

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2012

Primary clavicle tumors and tumorous lesions: a review of 206 cases in East Asia

Arthroscopic three dimensional autologous chondrocyte transplantation with navigation-guided cartilage defect size assessment

The epidemiology of knee injuries in children and adolescents

Analysis of hereditary and medical risk factors in Achilles tendinopathy and Achilles tendon ruptures: a matched pair analysis

The comparison of the effect of corticosteroids and platelet-rich plasma (PRP) for the treatment of plantar fasciitis

Risk factors for failure to return to the pre-fracture place of residence after hip fracture: a prospective longitudinal study of 444 patients