Re-attachment of the tuberosities of the humerus following hemiarthroplasty for four-part fracture

Abstract

This study evaluated the effect on movement under load of three different techniques for re-attachment of the tuberosities of the humerus using test sawbones. In the first, the tuberosities were attached both to the shaft and to each other, with one cerclage suture through the anterior hole in the prosthesis. The second technique was identical except for omission of the cerclage suture and in the third the tuberosities were attached to the prosthesis and to the shaft. An orthogonal photogrammetric system allowed all segments to be tracked in a 3D axis system. The humeri were incrementally-loaded in abduction, and the 3D linear and angular movements of all segments were calculated. Displacement between the tuberosities and the shaft was measured. The first and second techniques were the most stable constructs, with the third allowing greater separation of fragments and angular movement. Separation at the midpoint of the tuberosities was significantly greater using the latter technique (p < 0.05). The cerclage suture added no further stability to the fixation.

Tuberosity healing after reverse shoulder arthroplasty for acute proximal humerus fractures: the “black and tan” technique

“…1,13,[19][20][21]24,25,27 The suture construct chosen for tuberosity repair is critical to prevent displacement and to maintain position of the fracture fragments. 1,13 Implant design has been adapted to accommodate suture fixation to the stem, fins to resist rotational stress, and larger surface areas for tuberosity healing with bone-graft voids and ongrowth/ingrowth surfaces. 19,24,25 Structural bone grafts have also been used to enlarge the area for tuberosity repair and healing potential.…”

Attachments of muscles as landmarks for implantation of shoulder hemiarthoplasty in fractures

“…An accurate and stable fixation of the tuberosities with rotator cuff attachments is much more important. 1,9,16,19 Conclusion We described positions of the margins of tuberosities with respect to the axis of the humeral head. We assumed that surgeons may make rather large angular deviations during the procedure which can lead to a poor clinical outcome.…”

Proximal humeral fractures

“…The humeral canal is prepared and the humeral component is trialed and implanted, ensuring appropriate height, head size, offset, and version. Restoration and healing of the tuberosities has been shown to be the most critical portion of the reconstruction and, as such, much has been written about improving techniques to promote stability and tuberosity healing [8,44,[46][47][48][49][50]. The techniques involve suturing the tuberosities to each other and to the prosthesis, with some incorporating cerclage with cable or suture and/or bone grafting.…”