title: Can surgeons predict what makes a good hemiarthroplasty for fracture?
abstract: BACKGROUND
  The purposes of this study were (1) to identify the risk factors for tuberosity complications and poor functional outcomes and (2) to compare a standard humeral stem with a fracture-specific humeral stem in hemiarthroplasty for the treatment of 3- and 4-part proximal humeral fractures.
  
  
  METHODS
  We retrospectively reviewed the cases of 60 consecutively operated patients (61 shoulders) using radiographs and computed tomography scans. There were 56 displaced four-part and 5 three-part fractures. The technique was standardized for prosthesis positioning in height and retroversion and for tuberosity fixation. A conventional standard stem was implanted in the first 31 shoulders (group A), and a specific fracture stem was implanted in the next 30 shoulders (group B). The sample size needed for comparison was predetermined with an a priori power analysis. The mean follow-up period was 64 months (range, 24 to 150 months).
  
  
  RESULTS
  At the last follow-up, the greater tuberosity was healed in an adequate (anatomic) position in 45% of the patients in group A (14 of 31) and 87% of those in group B (26 of 30) (P = .0001). Active forward elevation, active external rotation, and the Constant score were significantly better with fracture stems (136°, 34°, and 68 points, respectively) than with conventional stems (113°, 23°, and 58 points, respectively) (P < .0001). Regardless of the type of implant used, patients aged 75 years or older and women had significantly lower functional results and higher rates of tuberosity complications (P < .0001).
  
  
  CONCLUSIONS
  Good functional outcomes can be anticipated after hemiarthroplasty for proximal humeral fractures if the greater tuberosity is anatomically positioned (ie, lateral to the stem) and healed around the prosthesis. The use of a specific fracture stem allows to double the rate of tuberosity healing compared to a conventional stem (87% vs. 45%), decreases complications and improves shoulder function. Risk factors associated with poor functional results and anatomic failures are (1) patient age (≥75 years), (2) patient gender (women), and (3) use of a conventional (bulky) stem.
authors.affiliation: Department of Orthopaedics and Sports Traumatology, Hôpital de l'Archet 2, Université de Nice-Sophia-Antipolis (UNSA), Nice, France. Electronic address: boileau.p@chu-nice.fr.
authors.forename: Pascal
authors.initials: P
authors.lastname: Boileau
authors.forename: Matthias
authors.initials: M
authors.lastname: Winter
authors.forename: Alec
authors.initials: A
authors.lastname: Cikes
authors.forename: Yung
authors.initials: Y
authors.lastname: Han
authors.forename: Michel
authors.initials: M
authors.lastname: Carles
authors.forename: Gilles
authors.initials: G
authors.lastname: Walch
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Schwartz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017102:Fracture Healing; D062785:Hemiarthroplasty / Q000295:instrumentation*; D006801:Humans; D007595:Joint Prosthesis; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed
keywords: Level III; Proximal humeral fractures; Retrospective Cohort; Treatment Study; hemiarthroplasty; tuberosity malunion; tuberosity nonunion