Hemiarthroplasty in complex proximal humeral fractures: preserving unity of the tuberosities with the cap technique improves clinical outcome

OBJECTIVES: The outcome of primary hemiarthroplasty for complex proximal humeral fractures is highly dependent on the position and survival of the tuberosities. Preserving the cuff–tuberosity complex as a unit (named cap technique) is thought to improve the reduction and stability of the tuberosities. We present the first report of the cap technique and compare it with the common intertubercular split technique. DESIGN: Comparative retrospective study on consecutive patients SETTING: Urban level 1 trauma center. PATIENTS/PARTICIPANTS: Included were all patients treated between May 2010 and August 2019 with the Affinis Fracture (Mathys, Switzerland) hemiarthroplasty for complex shoulder fractures. The cap technique was used from February 2015 onward. Minimum follow-up of 11 months. Dementia was an exclusion criterium. OUTCOME MEASURE: Clinical evaluation by (normalized) Constant-Murley score, DASH score, and EQ5D-VAS score. Radiological outcomes according to the criteria of Boileau. RESULTS: The cap-technique group consisted of 26 patients. One patient had revision surgery; 23 patients could be evaluated at a mean follow-up of 28 months. The control group consisted of 26 patients. Three patients had revision surgery. Ten patients could be scored at a mean follow-up of 101 months. A statistically significant difference in Constant-Murley score (P = .0121) could be observed between case and control group. There were no significant differences between radiological scores and between revision rates. CONCLUSION: The cap technique significantly improves clinical outcome in comparison with the intertubercular split technique. However, there was no significant difference in radiographic appearance of the tuberosities.