Elsevier

Journal of Shoulder and Elbow Surgery

Volume 17, Issue 5, September–October 2008, Pages 709-714
Journal of Shoulder and Elbow Surgery

Original Article
Reconstruction of humeral length and centering of the prosthetic head in hemiarthroplasty for proximal humeral fractures

https://doi.org/10.1016/j.jse.2008.03.004Get rights and content

Anatomic reconstruction of humeral length in hemiarthroplasty for complex proximal humeral fractures is difficult because reliable surgical landmarks are missing or are destroyed by the fracture. The pectoralis major tendon is a reliable landmark to determine prosthetic height intraoperatively. This study analyzed the clinical outcome, reconstruction of humeral length, centering of the prosthetic head in the glenoid, and tuberosity positioning and healing, using the pectoralis major tendon as a reference intraoperatively. The study included 30 patients. In 21 patients (group 1), humeral length reconstruction was performed using the pectoralis major tendon as a reference; in 9 (group 2), this reference was not used. Patients underwent a clinical and radiologic evaluation at a mean of 22.7 months. Group 1 showed significantly better results in clinical and radiologic values, especially in anatomic reconstruction of humeral length, than group 2. Clinical outcome depended significantly on greater tuberosity healing and centering of the prosthetic head in the glenoid.

Section snippets

Materials and methods

Between February 2002 and May 2006, 43 patients were treated by hemiarthroplasty for proximal humeral fractures and monitored for a minimum of 12 months. Subsequently, 4 patients died of unrelated causes, 4 had moved and could not be contacted, 3 could not be reexamined because of their poor medical condition and they were unable to take part in the study, 1 was excluded for a periprosthetic fracture, and the prosthesis in 1 had to be revised because of poor functional results and pain 1 year

Clinical evaluation

The mean absolute CS of all patients was 47.7 ± 20.0 points, with a mean agCS of 70.7% ± 31.1%. The mean DASH score was 39.8 ± 19.7 points. When the 2 groups were separated according to the intraoperative use of the pectoralis major tendon as a reference, the mean agCS of group 1 was significantly higher than in group 2 (P = 0.45). The mean absolute CS of group 1 was also higher than the mean absolute CS of group 2; however, this difference was not statistically significant (Table II). The

Discussion

Hemiarthroplasty for proximal humeral fractures is difficult and clinical outcome varies. Reconstruction of humeral length and centering of the prosthesis is critical for clinical outcome and anatomic positioning and healing of tuberosities.2, 16, 24 However, correct anatomic reconstruction of the proximal humerus with regard to the ratio between the greater and lesser tuberosities and the prosthetic head, prosthetic height, and retroversion is challenging, even for experienced surgeons.

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  • Cited by (21)

    • Is the pectoralis major tendon a reliable reference for restoration of humeral length with fracture hemiarthroplasty?

      2018, Journal of Shoulder and Elbow Surgery
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      To statistically validate this regression model and derived equations, R2 and Durbin-Watson values were used, and these statistical values confirmed that our regression model and the equation were reliable and applicable to actual treatment. PMTD has been advocated as a way to determine the height of a prosthesis.12,13,28 If a predictable PMTD measurement as a patient's individual value is developed, it can be used in reconstruction of humeral length in prosthetic replacement.

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      Also, the implant should be placed in such a way that allows the greater and lesser tuberosities to be placed below the level of the head. Alternative techniques for establishing height include referencing off the insertion of the pectoralis major insertion37,38 and reconstruction of the “gothic arch” based off the medial calcar.36 Finally, a trial humeral head is selected and placed (Fig. 3B).

    • Shoulder arthroplasty for acute proximal humerus fracture

      2010, Revue de Chirurgie Orthopedique et Traumatologique
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