The delayed effect of the radiologic parameters and fatty infiltration with hemiarthroplasty after porximal humerus fracture

Regarding the results of hemiarthroplasty after fracture, besides the factors related to the patient preoperatively and postoperative rehabilitation, anatomic restoration of the proximal humerus is also important. In this study, the aim is to determine the clinical association of the final position of the tuberculum majus after the proximal humerus restoration according to the rate of fatty infiltration of the rotator cuff, indicated by radiological measurements. The patients with proximal humerus fracture who underwent acute hemiarthroplasy surgery in our clinic between 2002 and 2010 was 131; 25 of them who have post-operative shoulder computed tomography with axial sections were included in this study. The mean follow-up was fiveyears The distance between the distal end point of the prosthesis and lateral humeral offset, lateral glenohumeral ofset ,the tuberculum majus are evaluated. By using the axial section of the computed tomography, the distance between the tuberculum majus and minus, retroversion of the prosthesis, the distance between the tuberculum majus and prosthesis and the rate of fatty degeneration of the rotator cuff are all evalualted. The clinical relationship between the WORC, ASSES, DASH and Constant- Murley scoring systems was revealed by using radiologic measurements. Our patient population includes 16(%76) women and 9(%24) men aged 52 to 84 (mean:68,2) years. Their mean WORC, ASSES, DASH and Constant-Murley scores were 55, 70, 23, 66 respectively. The patient group that have normal retroverted prothesis had higher scores in WORC DASH and Constant-Murray tests and lower in DASH index. (p<0,05) Patient group which have 0-5 mm distance between prothesis and great tubercle in axial CT scans had better clinical outcomes. p<0,05) better clinical outcomes were noted in grade 0 fatty infiltration group. (p<0,05) Although outcomes of hemiarthroplasty after acute fractures is multifactorial process; we revealed better functional outcomes after gretaer tubercle reconstruction as indicated. Keywords: hemiarthroplasty, great tubercle, fatty infiltration