Upper Arm Bone Fractures (Proximal Humerus Fractures): Reverse Total Shoulder Replacement

Upper Arm Bone Fractures (Proximal Humerus Fractures): Reverse Total Shoulder Replacement

The following video is a surgical demonstration of a reverse total shoulder replacement used for the treatment of an upper arm bone fracture, also known as a proximal humerus fracture. Here we have a right shoulder. The shoulder has been cleaned and an antimicrobial barrier has been applied to the skin giving it a yellowish appearance. The surgeon has marked out where they want to make their incision on the front of the shoulder using skin marker.

The incision is made and the surgeon continues to dissect down to the shoulder joint. After the surgical approach to the shoulder joint is complete, the surgeon will remove the ball of the shoulder, known as the humeral head, that is fractured. Next, the surgeon will prepare the socket of the shoulder. In a reverse total shoulder replacement, the ball and socket of the shoulder joint switch places, so the surgeon will prepare to place a ball where the socket normally is.

A pin guide is positioned and a pin is introduced into the central hollow portion of the guide. This pin remains and the guide is removed. Several instruments are introduced over this pin to perform steps that prepare the bone for the final implant, including sizing and soft tissue removal. Once the bone is prepared, the first portion of the implant, called a base plate, is secured into the prepared surface. Screws are then introduced into the base plate to provide additional support.

Next, the appropriately sized metal ball, called a glenosphere, is introduced and seated on top of the base plate and impacted into position. Now that the socket side is complete, the surgeon will go back to the upper arm bone to finish the surgery. The center of the upper arm bone will now be prepared for the metal stem by introducing a series of instruments to help prepare the bone and determine the size of the final stemmed implant.

The surgeon can now place the final implants in the upper arm bone, including the stem, metal cup, and the plastic liner, which will act as the new cartilage of the shoulder joint. The new ball and socket are then put back together and the surgeon will turn their attention to the other fractured pieces of bone. These pieces are often still attached to the rotator cuff tendons. If the bone quality of these pieces is sufficient, the surgeon may choose to secure them around the implant using suture to encourage healing, which has been shown to improve range of motion and function after surgery.

Once the surgery is complete, the surgeon will close the soft tissue and skin followed by placement of a surgical dressing.