Upper Arm Bone Fractures (Proximal Humerus Fractures): Bone and Tendon Repair During Shoulder Replacement Animation

Upper Arm Bone Fractures (Proximal Humerus Fractures): Bone and Tendon Repair During Shoulder Replacement Animation

This animation demonstrates bone and tendon repair during a reverse shoulder replacement for the treatment of an upper arm bone, or proximal humerus, fracture. Depending on the severity of an upper arm bone fracture, the shoulder joint may need to be replaced to restore stability for the bone to heal.

When there are multiple fractures in the top of the upper arm bone, the surrounding bone and tendon may also have to be repaired around the metal implants. Here, we see a right shoulder with the front of the shoulder facing the screen. First, an incision is made along the front of the shoulder, and the top of the upper arm bone, called the humeral head, is removed from the shoulder.

Two sutures with loops at the ends are then placed through the rotator cuff tendons at the back and front of the shoulder. The shoulder socket is then replaced with a metal implant. Because this is a reverse shoulder replacement, the ball and socket parts of the shoulder joint are switched, where a metal ball replaces the shoulder socket, and a metal socket replaces the ball shaped humeral head.

Two holes are drilled through the upper arm bone. Sutures are passed through these holes to be used later in the procedure. Additional new sutures are threaded through the openings in the metal stem implant that will be inserted into the upper arm bone. Once the metal stem implant is placed, the sutures from one side of the implant are threaded through the suture loops that are threaded through the rotator cuff tendon in the back of the shoulder.

The upper arm bone is realigned in place, and the sutures from the other side of the implant are threaded through the suture loops that are threaded through the rotator cuff tendon in the front of the shoulder. Tension is applied to these sutures to secure the bones and tendons together. Once positioned in place, suture strands from the front and back of the shoulder are tied together to secure the bone in place.

Next, 1 strand of suture from 1 of the holes drilled in the upper arm bone is then passed through both of the rotator cuff tendons and tied to 1 strand of suture from the other hole. The same steps are repeated for a suture strand from the other hole. The skin incision will be closed with sutures and the surgery is complete.