title: 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.
abstract: OBJECTIVE
  The stability of 2 fixation techniques for the tuberosities in patients with 3- or 4-part proximal humerus fractures treated with hemiarthroplasties was compared.
  
  
  METHODS
  Retrospective review of a nonrandomized sequential series of patients.
  
  
  METHODS
  Level I university orthopaedic surgery department.
  
  
  METHODS
  A consecutive series of 58 patients (average age, 64 years) from 1990 to 1999 with 3- and 4-part fractures of the proximal humerus.
  
  
  METHODS
  In group 1, 31 patients were treated with either a Neer or Aequalis shoulder prosthesis using nonabsorbable sutures and no bone graft for the reattachment of the tuberosities. In group 2, 27 patients were treated with either an Aequalis or Epoca shoulder prosthesis and a combination of cable fixation and bone grafting.
  
  
  METHODS
  At follow-up (average, 32 months), radiographs were taken to confirm tuberosity fixation or degree of displacement or resorption. Functional outcome was assessed by the Constant-Murley Score.
  
  
  RESULTS
  Significantly more dislocated tuberosities were found radiographically in group 1 (10 of 13 in total, P = 0.011), and significantly more tuberosities were resorbed in group 1 (9 of 12 in total, P = 0.012). Significant differences in functional results among healed versus failed tuberosity fixation were observed for activity of daily living (P = 0.05), range of motion (P = 0.002), strength (P = 0.01), the total score (P = 0.008), and the passive rotation amplitude (P = 0.04).
  
  
  CONCLUSIONS
  In hemiarthroplasties for proximal humeral fractures, the reattachment of the tuberosities with cable wire and bone grafting gives consistently better radiographic and functional results than with suture fixation alone.
authors.affiliation: Department of Orthopedic Surgery, Inselspital, Berne, Switzerland. fabian.krause@insel.ch
authors.forename: Fabian G
authors.initials: FG
authors.lastname: Krause
authors.forename: Lars
authors.initials: L
authors.lastname: Huebschle
authors.forename: Ralph
authors.initials: R
authors.lastname: Hertel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000295:instrumentation*; D016025:Bone Transplantation / Q000295:instrumentation*; D001864:Bone Wires; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011859:Radiography; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome