Original ArticleReconstruction of humeral length and centering of the prosthetic head in hemiarthroplasty for proximal humeral fractures
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)
Referencing the pectoralis major tendon for humeral stem height placement in reverse shoulder arthroplasty for fracture
2021, Seminars in Arthroplasty JSESIs the pectoralis major tendon a reliable reference for restoration of humeral length with fracture hemiarthroplasty?
2018, Journal of Shoulder and Elbow SurgeryCitation Excerpt :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.
Height landmark and semi-arthroplasty for shoulder fracture: Measuring the distance between humeral head apex and pectoralis major
2013, Revue de Chirurgie Orthopedique et TraumatologiqueHemiarthroplasty for Four-Part Fractures of the Proximal Humerus
2011, Operative Techniques in OrthopaedicsCitation Excerpt :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).
Metaversion can reliably predict humeral head version: A computed tomography-based validation study
2010, Journal of Shoulder and Elbow SurgeryShoulder arthroplasty for acute proximal humerus fracture
2010, Revue de Chirurgie Orthopedique et Traumatologique