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Study: Large metaphyseal volume fracture-prosthesis shows good results
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A large metaphyseal volume fracture-prosthesis had a 14% failure rate and while substantial resorption of the greater tuberosity was frequent, it was not associated with functional incompetence of the rotator cuff, according to a study from Swiss researchers.
Researchers implanted 30 hemiarthroplasties for acute, complex, proximal humeral fractures in 30 patients. One patient was lost and two patients could only be interviewed by telephone. Two patients underwent revisions due to secondary displacement of the greater tuberosity (GT) within the first 2 years after surgery. The researchers assessed the remaining 25 patients at a mean of 25 months.
According to study results, the GT healed in 23 patients and CT documented severe resorption of GT in 12 cases without displacement of a measurable bone fragment and an intact clinical cuff function with a radiographically preserved acromio-humeral distance. The mean anterior elevation was 117° and the mean subjective shoulder value was 70%. Researchers found tuberosity dislocation occurred in four cases, which was associated with an increase of fatty infiltration and poor result.
“The overall results obtained justify its continued use,” the researchers concluded.
Disclosure: The researchers have no relevant financial disclosures.
Perspective
Back to TopMorten Schultz Larsen, MD
This study addresses a fracture type where results after surgery are less than satisfactory and in fact not convincingly better than nonoperative treatment.
The role of the greater tuberosity (GT) is well known and the authors demonstrate in an impressive surgical series that it is possible to achieve anatomical fixation of the GT and this yields good, but not great, results.
Unfortunately it is not clear what consecutive means in this study, and this combined with the absence of a control group and rather young patients in the study, does limit the use of the conclusions.
It seems that we have a new tool in the box for treating certain proximal humerus fractures, but the superior treatment has still not been found.
Perspective
Back to TopYaiza Lópiz, PhD, MD
Although retrospective, this study has some potential strengths: 1) The surgical acts were all carried out by two experienced surgeons; 2) The technique was systematically reproduced to ensure correct height of the prosthesis and a standardized suturing technique for the reattachment of the tuberosities; 3) The time of surgery was early post-injury to avoid lower functional outcomes. One potential limitation is the length of follow-up, with an average of 2 years. It was perhaps too short as the results obtained may deteriorate with time. Doubts are raised regarding the rate of greater tuberosity resorption and a declared intact clinical cuff without implant migration.
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