This prospective multicenter study followed 66 patients after hemiarthroplasty for displaced 3- and 4-part proximal humeral fractures. It asked why outcomes are so unpredictable by correlating clinical results with the radiographic fate of the tuberosities and the prosthesis. The focus is on which technical errors drive failure.
When a hemiarthroplasty for a proximal humeral fracture fails, look at the tuberosities first. This paper shows that half of failures trace to tuberosity malposition or migration, and that the prosthesis position drives the tuberosity. Get the implant right and the tuberosities can heal; get it proud or over-retroverted and no suture technique will hold them.
Two numbers anchor the operation. Set the greater tuberosity 5-10 mm below the head, and keep retroversion under 40°. A proud prosthesis (>10 mm long) and retroversion above 40° each independently predict failure, and together with a low tuberosity form the 'unhappy triad.'
Err low rather than proud, since shortening is tolerated up to 15 mm while lengthening is not. In elderly osteopenic women, slow the rehab.
This prospective multicenter study followed 66 patients after hemiarthroplasty for displaced 3- and 4-part proximal humeral fractures. It asked why outcomes are so unpredictable by correlating clinical results with the radiographic fate of the tuberosities and the prosthesis. The focus is on which technical errors drive failure.
When a hemiarthroplasty for a proximal humeral fracture fails, look at the tuberosities first. This paper shows that half of failures trace to tuberosity malposition or migration, and that the prosthesis position drives the tuberosity. Get the implant right and the tuberosities can heal; get it proud or over-retroverted and no suture technique will hold them.
Two numbers anchor the operation. Set the greater tuberosity 5-10 mm below the head, and keep retroversion under 40°. A proud prosthesis (>10 mm long) and retroversion above 40° each independently predict failure, and together with a low tuberosity form the 'unhappy triad.'
Err low rather than proud, since shortening is tolerated up to 15 mm while lengthening is not. In elderly osteopenic women, slow the rehab.