Tuberosity refixation in reverse proximal humerus fracture arthroplasty: a prospective cohort study with two-year follow-up

INTRODUCTION: To evaluate the outcomes of a simplified tuberosity refixation technique using a two-suture construct in patients with complex proximal humerus fractures treated with reverse shoulder arthroplasty (RSA). The technique reduces the number of fixation sutures rather than the traditional four to five, aiming to decrease operative complexity while promoting greater tuberosity (GT) healing and improving the healing rate. A secondary exploratory analysis compared clinical and radiological outcomes between cemented and uncemented humeral stem fixation. MATERIALS AND METHODS: This prospective study included 73 patients who underwent RSA (Global Unite Fracture Reverse System, DePuy Synthes, Warsaw, Indiana, USA). Clinical and radiological outcomes were assessed at two-year follow-up. Bone quality was evaluated using the Deltoid Tuberosity Index (DTI). Functional outcomes and GT healing were analyzed, and stem fixation type was assessed in a secondary subgroup analysis. RESULTS: The mean patient age was 79 ± 8 years (range 61-95), and 65 (89%) were female. Osteoporotic bone quality (DTI < 1.4) was observed in 51 (70%) of cases. At two years, the median outcome scores were: Subjective Shoulder Value, 90 (IQR 80-95); Constant-Murley score, 76 (IQR 73-81); active forward flexion, 140° (IQR 120-160); abduction, 140° (IQR 120-160); external rotation, 8 (IQR 8-8); and internal rotation, 6 (IQR 6-8). GT healing occurred in 68 (93%) patients. Dislocation occurred in 5 (7%) patients. Complications occurred in 4 (5.5%) patients, and 1 (1.4%) required revision surgery. In the exploratory comparison, cemented stems demonstrated slightly greater forward flexion (p = 0.02) and abduction (p = 0.045), without clinically relevant differences between fixation types. CONCLUSIONS: The simplified two-suture greater tuberosity refixation technique achieved high GT healing rates and favorable functional outcomes, supporting its use in RSA for complex proximal humerus fractures. Stem fixation method did not have a clinically relevant influence on outcomes.