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Restoring anatomy, tuberosity healing among keys to success in shoulder hemiarthroplasty
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CHICAGO — When treating a shoulder fracture with hemiarthroplasty, the keys to success include restoring anatomy and obtaining tuberosity healing, according to a presentation, here.
According to Bradford O. Parsons, MD, it is rare when an orthopedic surgeon performs a hemiarthroplasty for a shoulder fracture.
“That is a younger, more active patient in their 50s or early 60s. They have a good, strong tuberosity bone, so it is not comminuted in six pieces; they have a good cuff; they are young not only in age, but in spirit; and they have demands that I think they would be a little bit concerned for reverse,” Parsons said in his presentation at the American Shoulder and Elbow Surgeons Open Symposium.
In his presentation, Parsons noted is it important to have the right prosthetic design when performing a hemiarthroplasty. Surgeons also want to restore the patient’s normal anatomy, he said.
“The key is meticulous attention to fix the tuberosity in an anatomic position relative to each other and to the head, and then obviously you have to rehab them appropriately, so you do not have the tuberosities pull off,” Parsons said.
According to Parsons, there are fracture fixation systems available that allow for tuberosity fixation and multiple suture holes.
“A lot of these systems have jigs or apparatuses that allow to maintain version and height in our trial [components], and we look at trials to find the stem without losing any of our anatomic restoration,” Parsons said.
He added surgeons should know where the coracoid is, inspect the glenoid for fractures and be aware of any axillary nerve issues the patient may have. To achieve the right position of the tuberosity, Parsons said use of fluoroscopy is mandatory. Surgeons should also be sure to keep the new head at the height of the articular surface, and to choose an undersized head if the patient is in between sizes to reduce the risk of tension. – by Casey Tingle
Reference:
Parsons BO. Anatomic hemiarthroplasty for fracture — A lost art: Indications, implant choice and tuberosity management. Presented at: American Shoulder and Elbow Surgeons Open Symposium; Oct. 11, 2018; Chicago.
Disclosure: Parsons reports he receives IP royalties from, is a paid consultant and paid presenter or speaker for Arthrex Inc.