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

Abstract

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. 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. 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). In our collective adding an encircling steel cable for the fixation of the tuberosities resulted in higher anatomical healing rates.