Artikel
Cow-hitch suture cerclage for fixation of the greater tuberosity in fracture reverse total shoulder arthroplasty in elderly patients with a minimum follow-up of 2 years: A case-control study
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Autoren
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Flamur Zendeli
- Universitätsklinik Balgrist, Zürich, Switzerland
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Philipp Kriechling
- Universitätsklinik Balgrist, Zürich, Switzerland
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Samy Bouaicha
- Universitätsklinik Balgrist, Zürich, Switzerland
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Sabine Wyss
- Universitätsklinik Balgrist, Zürich, Switzerland
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Karl Wieser
- Universitätsklinik Balgrist, Zürich, Switzerland
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Florian Grubhofer
- Universitätsklinik Balgrist, Zürich, Switzerland
| Veröffentlicht: | 21. Oktober 2024 |
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Gliederung
Text
Objectives: Reverse total shoulder arthroplasty (RTSA) is a well-established treatment option for complex proximal humerus fractures in elderly patients.
One important factor for good clinical outcomes is the healing of the greater tuberosity (GT). The purpose of this study was to compare the outcomes of patients receiving GT refixation with a so-called “cow hitch” (CH) suture cerclage fixation or with a standard suture cerclage fixation technique at a minimum follow-up of 2 years.
Methods: A retrospective case-control study was performed with 20 patients who underwent RTSA with CH fixation of the GT compared to a control group including 51 patients after RTSA with a standard suture cerclage fixation of the GT.
Radiological healing of the GT was defined as the primary outcome parameter and was assessed with standard radiographs at last follow up visit. Clinical outcome was assessed as the secondary outcome parameter and was measured with the absolute and relative Constant-Murley score (aCS and rCS), subjective shoulder value (SSV), range-of-motion (ROM) assessment and patient's reported outcome satisfaction (PROM).
Results and conclusion: The mean follow-up duration was 37 ± 16 months in the CH group and 35 ± 15 months in the control group (P = .95). The radiographic findings revealed a 95% healing rate of the GT in the CH group compared to 75% healing rate in the control group (P = .09). No secondary displacement of the GT was observed in the CH group compared to 8 cases (15%) in the control group (P = .1).
At the latest follow-up, the aCS was significantly higher in the CH group than in the control group (68 ± 12 points vs 62 ± 14 points) (P = .04). The rCS and SSV was comparable between the two groups (82 ± 13% vs 82 ± 18% (P = .06) and 86 ± 11% vs. 83 ± 18% (P = 1), respectively). The CH group showed significantly better external rotation compared to the control group (31 ± 15° vs 18 ± 16°) (P = .01). No significant differences were observed for flexion and abduction. PROMs were comparable between the two groups.
The use of CH suture cerclage for refixation of the GT in RTSA following complex proximal humerus fractures was noninferior to the single suture cerclage in terms of radiographic outcomes and PROMs but showed better external rotation.
