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Duke Orthopaedics
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Wheeless' Textbook of Orthopaedics

Shoulder Replacement for Proximal Humeral Fracture:

- Discussion:
   - 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.


- references: 
- 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