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


CONCLUSIONS
In our collective adding an encircling steel cable for the fixation of the tuberosities resulted in higher anatomical healing rates.
Centre for Musculoskeletal Surgery, University Medical Centre, Johannes Gutenberg-University Mainz, Langenbeck-Str. 1, 55131 Mainz, Germany. sven-oliver.dietz@unimedizin-mainz.de
Sven-Oliver
SO
Dietz
Paul
P
Broos
Stefaan
S
Nijs
D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000379:methods*; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D018709:Statistics, Nonparametric; D013536:Suture Techniques; D016896:Treatment Outcome