A technique for passing tuberosity-implant cerclage ribbons in fracture-inverse total shoulder arthroplasty

Abstract

Complex proximal humerus fractures are difficult to treat particularly in patients above 65 years with osteoporotic bone and disturbed anatomical landmarks. Fracture-inverse total shoulder arthroplasty has shown a good treatment option for these injuries. However, better results are associated with meticulous reduction and fixation of the tuberosities around the implant. The purpose of this study is to describe a simple technique to pass cerclage ribbons to fix the tuberosities together around the inverse total shoulder arthroplasty. MethodsThis is a retrospective cohort study that was performed from January 2019 to January 2021. Thirty-five shoulders with 3- & 4-part proximal humerus fractures had undergone fracture-inverse total shoulder arthroplasty with a special technique for tuberosities repair. Follow-up was a minimum of 24 months. ResultsThe tuberosity healing rate was 86%. Complete resorption of one or more tuberosities occurred in 8%, and tuberosity migration and nonunion were present in 6%. ConclusionThis surgical technique offers a simple way for passing cerclage ribbons in fracture-inverse total shoulder arthroplasty for fixing the tuberosities together and to the implant. It has been shown to encourage tuberosity healing which improves shoulder stability and results in more optimal restoration of shoulder function.