Highlights
- •We evaluated the outcome after ORIF and biceps tenodesis for treating proximal humerus fractures.
- •56 patients were enrolled(Tenodesis group: 26 patients; Control group: 30 patients).
- •Tenodesis revealed superior MSQ-, SPADI- and DASH-score. Especially throwing motion was significantly enhanced.
- •There was no significant difference regarding anatomic deformity including the Popeye sign.
- •We regard tenodesis as a promising adjunct to ORIF of proximal humerus fractures.
Abstract
Background
Fractures of the proximal humerus are often associated with lesions of the long head
of the biceps (LHB) tendon. This often leads to prolonged shoulder pain. Hence, many
surgeons decide to perform a tenodesis of the LHB tendon simultaneous to ORIF. The
purpose of this study was to evaluate the postoperative outcome after interlocking
plate fixation and biceps tenodesis for treating proximal humerus fractures.
Methods
56 patients (38 females, 18 male) suffering from proximal humerus fractures who underwent
surgery were retrospectively included. 26 of these 56 patients (19% Neer II, 38% Neer
III, 43% Neer IV) were treated with simultaneous tenodesis of the LHB tendon when
ORIF using interlocking plate fixation was performed. 30 patients (17% Neer II, 40%
Neer III, 43% Neer IV) served as control group receiving only interlocking plate fixation.
The patients were asked to complete the Munich Shoulder Questionnaire (MSQ) for evaluation
of postoperative shoulder function. Results of the Disabilities of the Arm, Shoulder
and Hand (DASH) Score and Shoulder Pain and Disability Index (SPADI) were calculated
from the MSQ. Patients were clinically evaluated for a positive O’Brien test and Popeye
sign.
Results
The tenodesis group demonstrated significant superior outcome regarding the MSQ (mean
90.47 points vs. 79.41 points, p = 0.006), DASH Score (mean 4.2 points vs. 16.81 points,
p = 0.017) and SPADI (mean 94.59 points vs. 83.56, p = 0.045). Flexion, external rotation
and the capability of throwing a soft ball were significantly improved in the tenodesis
group compared to the control group. The O’Brien test as indicator for lesions of
the LHB was positive in fewer patients of the tenodesis group (2/26, vs. 21/30, p = 0.001).
There was no significant difference of a positive Popeye Sign.
Conclusion
Our results show evidence of an improved shoulder function when a simultaneous tenodesis
of the LHB tendon is performed during treatment of proximal humerus fractures using
interlocking plate fixation.
Keywords
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Published online: February 09, 2019
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