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

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

This surgical animation will demonstrate the repair of an upper arm bone fracture using a reverse total shoulder replacement on a right shoulder. An upper arm bone fracture is treated with a reverse total shoulder replacement when the fracture causes enough damage to the blood supply of the bone, decreasing the chance of healing. The new metal and plastic implants allow the shoulder to move, and healing the bony fragments back together will preserve the rotator cuff muscles.

The surgeon makes the incision across the front of the shoulder, gaining access to the shoulder joint. The bony fragments that are still attached to the rotator cuff muscles are moved to the side. The ball of the shoulder, or humeral head, will be removed because the damaged blood supply will prevent it from healing. Looped sutures are passed through the rotator cuff muscles and are used later in the procedure.

First, all remaining cartilage is removed from the surface of the socket, and a pin guide is positioned. A pin is introduced into the central hollow portion of the guide. This pin remains, and the guide is then removed. Several instruments are introduced over this pin to prepare the bone for the final implant. Once the bone is prepared, the first portion of the implant, called a baseplate, is secured into the bone. Smaller screws are put through the baseplate to hold it in place.

Next, a metal ball, called a glenosphere, is put on top of the baseplate and impacted into position. A final screw is placed into the center of the glenosphere. After the socket side is complete, the surgeon will use different instruments to make room for the final stem to be placed in the bone. The temporary instruments are taken out. To fix the bony fragments back together with sutures, the first step is drilling holes in the arm bone, and sutures are passed through the holes.

Next, more sutures are put in the final implant through eyelets located in the cut portion. The implant is impacted into the bone. A plastic insert is then tapped into place. The 2 sutures in the back are passed through the rotator cuff first. Then the arm is rotated, and the joint is put back into place. The final 2 sutures are then passed through the rotator cuff in front. They are tied in a specific pattern that secures the bony fragments back together and around the implant, so that everything can heal in place.

The surgeon will make sure everything moves smoothly and stays in place before closing the incision. A bandage is placed over the incision and the surgery is complete.