Optimization of Tuberosity Healing in Prosthetic Reconstruction of Proximal Humerus Fractures

Achieving successful clinical outcomes after hemiarthroplasty for 4-part proximal humerus fractures remains a sobering challenge for even the experienced shoulder reconstruction sur‐ geon or traumatologist. Despite what appears to be secure tuberosity fixation at the time of wound closure, serial postoperative radiographs often reveal progressive displacement and/or resorption of the greater tuberosity.[1-3] This results in a situation akin to a posteriorsuperior rotator cuff tear, where most patients cannot generate sufficient cuff strength to sta‐ bilize the humeral head against the superior pull of the deltoid. Secondary mechanical consequences, including shoulder weakness, superior instability and trapezial substitution can compromise outcomes both in terms of shoulder function and pain in such circumstan‐ ces.[4, 5] Stiffness and cuff dysfunction frequently render the functional results only fair and many patients must accept a limited goals end result.[6-8]