Shoulder Replacement for Proximal Humeral Fracture:
- proper head hight:
- established by placing the articular surface of the prosthetic head at the midpoint of the glenoid
- with trial prosthesis in place, apply gentle traction and ensure that the prosthetic head remained within the glenoid fossa;
- tuberosity fixation:
- prior to cement fixation of the humeral stem, stay sutures are applied through the lateral and anterior aspects of the proximal shaft;
- previously applied stay sutures are placed into the greater tuberosity;
- horizontal fixation between the tuberosity fragments utilizing fin holes.
- emphasize the need for initial horizontal rather than vertical fixation (horizontal fixation avoids over reduction);
- consider a circumferential suture through the tuberosities, around the medial aspect of prosthetic neck, for additional stability;
- subscapularis tendon is then opposed at the anterior end of the construct;
- head to tuberosity distance (HTD) should be 8 - 10 mm, careful not to over reduce the tuberosity fragments;
- head to tuberosity distance greater than 10 mm will causing worsening pateint satisfaction scores (higher HTD = worsening scores);
- careful not to leave the stem too proud, not to have the humeral head too large, and not to over reduce the tuberosity (too low);
- over reduction w/ tuberosity malunion may cause attenuation or failure of the cuff with consequential late superior migration.
- Primary Hemiarthroplasty for Treatment of Proximal Humeral Fractures.
- Outcomes of hemiarthroplasty for fractures of the proximal humerus
- Outcomes for hemiarthroplasty for proximal humeral fractures deteriorate over years
- Suture fixation versus cable cerclage of the tuberosities in shoulder arthroplasty-clinical and radiologic results
- Hemiarthroplasty Versus Reverse Total Shoulder Arthroplasty for Acute Proximal Humerus Fractures in Elderly Patients
- Functional outcomes of reverse shoulder arthroplasty compared with hemiarthroplasty for acute proximal humeral fractures
- Internal Fixation Versus Shoulder Hemiarthroplasty for Displaced 4-part Proximal Humeral Fractures in Elderly Patients
- Proximal humeral fractures treated with hemiarthroplasty: Does tenodesis of the long head of the biceps improve results?
Original Text by Clifford R. Wheeless, III, MD.
Last updated by Data Trace Staff on Thursday, November 15, 2012 1:52 pm