• Stefan H Greiner, Gerd Diederichs, Iris Kröning, Markus Scheibel, and Carsten Perka.
• Department of Orthopedics, Center for Musculoskeletal Surgery, Berlin, Germany. Stefan.greiner@charite.de
• J Shoulder Elbow Surg. 2009 May 1;18(3):431-6.

HypothesisThis study investigates the correlation between tuberosity positioning, fatty infiltration of the rotator cuff, and clinical outcome after hemiarthroplasty for proximal humeral fracture.Materials And MethodsTwenty patients with a mean age of 70.8 +/- 9.9 years were evaluated at a mean of 19.8 +/- 9.4 months. Evaluation included assessment of the Constant score (CS); Disabilities of the Arm, Shoulder and Hand (DASH) score; radiographic evaluation; and computed tomography to classify healing of the tuberosities and changes in the rotator cuff. Fatty degeneration of the cuff was classified according to the Goutallier classification as stage 0 to 4. Tuberosity positioning was classified as mal-positioning of less than 0.5 cm., 0.5 to 1 cm., >1.0 cm., or not healed.ResultsThe mean Constant Score (CS) of patients with greater tuberosity displacement of <0.5 cm was significantly higher than the CS of patients with > or =0.5 cm displacement and non-united greater tuberosities. The CS of patients with greater tuberosity displacement of 0.5 to 1 cm was significantly higher than that in patients with non-united greater tuberosities. For the lesser tuberosity, patients with displacement of <0.5 cm showed significantly higher outcome scores than patients with displacement of >1 cm and non-united lesser tuberosities. There was a significant correlation between fatty infiltration of the supraspinatus and infraspinatus muscles and greater tuberosity malposition and between fatty infiltration of the subscapularis and lesser tuberosity malposition.ConclusionFatty infiltration of the cuff was significantly associated with lower clinical scores. Tuberosity positioning and healing are critical for improved clinical outcomes after hemiarthroplasty for proximal humeral fractures.

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