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

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. Design: Retrospective review of a nonrandomized sequential series of patients. Setting: Level I university orthopaedic surgery department. Patients: A consecutive series of 58 patients (average age, 64 years) from 1990 to 1999 with 3- and 4-part fractures of the proximal humerus. Intervention: 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. Main Outcome Measurements: 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). Conclusion: 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.