Upper Arm Bone Fractures (Proximal Humerus Fractures): All-Suture Cerclage Animation

Upper Arm Bone Fractures (Proximal Humerus Fractures): All-Suture Cerclage Animation

This animation demonstrates an all-suture cerclage technique for the treatment of an upper arm bone, or proximal humerus, fracture. Here, this surgical technique is used for an oblique proximal humerus fracture and uses flat braided suture to stabilize the broken bone to allow the fracture to heal.

This technique can also be used with different types of implants, like a plate and screws or a reverse shoulder replacement to help stabilize the fracture, replacing traditional metal wires. Here, we see inside the left shoulder facing from the side. The front of the shoulder is at the left side of the screen, and the back of the shoulder is at the right side of the screen.

An incision has already been made along the side of the shoulder, exposing the underlying humerus, or upper arm bone, with an oblique fracture through the top of the bone. A curved needle is used to pass flat sutures around the upper arm bone.

The tail of the sutures is removed from the needle and passed into the shuttle suture loop that is attached to the needle to pass the sutures around the upper arm bone a second time. Alternatively, a hook can be used to pass the sutures, those used for the repair and a suture shuttle loop.

Once passed around the upper arm bone, the tail of the repair sutures is removed from the hook and passed into the shuttle suture loop, which is pulled to complete the loop around the upper arm bone a second time. The suture tails are then threaded through a wire loop attached to a suture loader.

The tabs on the loader are separated to pull the sutures through the pre-tied knot on the loader. Once the tails are through the knot, the knot is removed from the loader. The sutures are then tightened around the upper arm bone.

The connected suture tails are cut to separate the 2 tails, which are inserted through the tip of an instrument called a tensioner that is used to tighten the sutures further. The tensioner is removed, and a knot is tied. The suture tails are further tightened with the tensioner and secured down with additional knots.

The suture tails are then cut off. If needed, additional sutures can be added to help stabilize the fracture. The skin incision will be closed with regular sutures, and the all-suture cerclage is complete.