Pectoralis major reference technique improves humeral height restoration and tuberosity healing after hemiarthroplasty for complex proximal humeral fractures: A comparative study.

Abstract

Accurate humeral stem positioning is critical for achieving favorable outcomes after hemiarthroplasty for complex proximal humeral fractures. This study aimed to compare the clinical and radiological outcomes of hemiarthroplasty performed using the pectoralis major reference technique (PMRT) with those performed using a conventional technique (CT) METHODS: Thirty-nine patients who underwent hemiarthroplasty for complex proximal humeral fractures were included in this study. The conventional technique was used in the first 24 cases (CT group) and PMRT was applied in the subsequent 15 cases (PMRT group). The mean follow-up period was 54.5 months (range, 12-96 months) in the PMRT group and 56.1 months (range, 24-132 months) in the CT group. Radiographic outcomes included postoperative head-tuberosity distance and tuberosity healing status, assessed using serial plain radiographs. Clinical outcomes were evaluated using the visual analog scale (VAS) pain score, the University of California, Los Angeles (UCLA) score, the American Shoulder and Elbow Surgeons (ASES) score, the subjective shoulder value (SSV), and active range of motions. The rate of complete tuberosity healing was significantly higher in the PMRT group than in the CT group (80.0% vs 58.3%). The mean postoperative head-tuberosity distance was significantly shorter in the PMRT group compared with the CT group (5.9 mm vs 11.8 mm). In the PMRT group, total humeral height did not differ significantly between the operated and contralateral sides (294.4 mm vs 293.4 mm). The PMRT group demonstrated significantly greater external and internal rotation than the CT group; however, no significant differences were observed in clinical scores, forward flexion, or abduction. The overall complication rates did not differ significantly between the two groups (26.6% vs 45.8%, p = 0.231). At the final follow-up, rotator cuff insufficiency was observed in 4 patients (26.7%) in the PMRT group and 9 patients (37.5%) in the CT group. Compared with the conventional technique, PMRT was associated with more favorable restoration of proximal humeral anatomy, improved tuberosity healing, and better postoperative rotational function following HA for complex proximal humeral fractures.