The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Anatomic Reduction of Greater Tuberosity Fragment for Shoulder Hemiarthroplasty: a Predictor of Good Clinical Outcome

Document Type : RESEARCH PAPER

Authors
Francesco Lazzarini 1
Marco Distefano 1
Tony Shen 2
Gregorio Secci 3
Michael Cresci 3
Raffaele Tucci 3
Luigi Zanna 1
1 Department of Orthopaedic Surgery, Santa Maria Annunziata Hospital, Florence, Italy
2 Adult Reconstruction and joint Replacement, Hospital of Special Surgery, New York, NY, USA
3 Department of Shoulder Surgery, AOU Careggi, University Hospital of Florence, Florence, Italy
10.22038/abjs.2023.74441.3448
Abstract
Objectives: Proximal humerus fractures account for four-five % of all fractures. Shoulder 
hemiarthroplasty is indicated for complex fractures with high complication rates when treated with ORIF. 
This study aims to evaluate the correlation between the proper intraoperative tuberosity reduction, and 
the mid-to-long-term clinical outcome in a series of patients treated with hemiarthroplasty after proximal 
humerus fracture.
Methods: Forty-one patients with proximal humerus fractures who underwent hemiarthroplasty surgery between 
July 2009 and December 2019 were retrospectively reviewed. Quantitative analysis of the reduction of the 
tuberosities was performed on postoperative X-rays focusing on the distance between reconstructed greater 
tuberosity and the apex of the head of the prosthesis, (head-tuberosity distance), and contact between tuberosity 
and humerus diaphysis. The University of California Los Angeles Score (UCLA) was calculated for each patient.
Results: The mean time to surgery was 6.29 ± 2.8 days (range 2-18 days). Nine patients out of 41 (22%) had non 
anatomic tuberosity, and 32 (78%) were anatomic reduced. The UCLA score at the final follow-up was good and 
excellent (≥27) in 27 patients (66%), and poor (<27) in 14 (34%). A significant correlation was observed between 
proper tuberosity reduction and good/excellent UCLA scores (P<0.001).
Conclusion: Hemiarthroplasty is a valid and reliable technique for the treatment of proximal humerus fracture not 
eligible for internal fixation, with high risk of failure. The proper tuberosity reconstruction, paying special attention to 
the HTD and the contact between the cortical of the humeral diaphysis and the reconstructed tuberosity, is essential 
to reach a good clinical outcome.
 Level of evidence: IV
Keywords
Clinical outcome
Hemiarthroplasty
Proximal humerus fractures
Shoulder
Tuberosities reduction
Subjects
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The Archives of Bone and Joint Surgery
Volume 12, Issue 2
February 2024
Pages 108-115

  • Receive Date 21 August 2023
  • Revise Date 29 November 2023
  • Accept Date 16 December 2023