Review of fixation techniques for the four-part fractured proximal humerus in hemiarthroplasty

Abstract

IntroductionThe clinical outcome of hemiarthroplasty for proximal humeral fractures is not satisfactory. Secondary fragment dislocation may prevent bone integration; the primary stability by a fixation technique is therefore needed to accomplish tuberosity healing. Present technical comparison of surgical fixation techniques reveals the state-of-the-art approach and highlights promising techniques for enhanced stability.MethodA classification of available fixation techniques for three- and four part fractures was done. The placement of sutures and cables was described on the basis of anatomical landmarks such as the rotator cuff tendon insertions, the bicipital groove and the surgical neck. Groups with similar properties were categorized.ResultsMaterials used for fragment fixation include heavy braided sutures and/or metallic cables, which are passed through drilling holes in the bone fragments. The classification resulted in four distinct groups: A: both tuberosities and shaft are fixed together by one suture, B: single tuberosities are independently connected to the shaft and among each other, C: metallic cables are used in addition to the sutures and D: the fragments are connected by short stitches, close to the fragment borderlines.ConclusionsA plurality of techniques for the reconstruction of a fractured proximal humerus is found. The categorisation into similar strategies provides a broad overview of present techniques and supports a further development of optimized techniques. Prospective studies are necessary to correlate the technique with the clinical outcome.

Hemiarthroplasty in complex proximal humeral fractures: preserving unity of the tuberosities with the cap technique improves clinical outcome

“…To the best of our knowledge all the technical and clinical papers reporting on the use of a HA in the treatment of PHF and all the company surgical technique manuals illustrate routinely a separation between the tuberosities before implanting the prosthesis and subsequently reconstruct the separated tuberosities around the prosthesis. [ 9 , 17 , 36 , 37 ]…”

Fracture-Dedicated Prosthesis Promotes the Healing Rate of Greater Tuberosity in Reverse Shoulder Arthroplasty: A Meta-Analysis

“…In addition to the design of the prosthesis and cementation, this difference in healing rates of the greater tuberosity may be attributed to different fixation techniques. Recent methods to enhance tuberosity healing include suture techniques (53)(54)(55)(56) and bone grafting (17,57,58). Although there is no consensus on the suture fixation of greater tuberosity, the main fixation method is the combination of vertical fixation and horizontal fixation with/without cerclage fixation.…”

Protesi di spalla in acuto

“…Alcuni di essi presentano superfici atte a favorire l'adesione dei frammenti tuberositari alla protesi, altri sono caratterizzati da corpi di piccole dimensioni e/o cavi per agevolare l'applicazione di innesti ossei e la consolidazione prossimale, altre ancora hanno numerosi fori prossimali o colletti traforati per consentire il passaggio dei fili di sutura e ottimizzare la fissazione periprotesica del complesso tuberosità-cuffia (Fig. 3) [21]. La più importante evoluzione di queste protesi è tuttavia consistita nello sviluppo di sistemi modulari a piattaforma, dove la componente omerale anatomica consta di tre parti fondamentali: stelo, corpo e testa (Fig.…”