RSA for Proximal Humeral Fractures
RSA for fracture can be implanted either through a deltopectoral or transdeltoid approach, according to surgeon’s preference and experience. The exposure influences some steps of the procedure, but the differences among the two approaches are not substantial.
The advantages of the deltopectoral approach include the excellent exposure of the joint space and the easy extension to the humeral shaft in case of need. The transdeltoid approach allows better access to the greater tuberosity and might facilitate periprosthetic reconstruction of the tuberosities.
There are two critical steps in the procedure: restoration of proper humeral length that can be challenging in fractures with severe shaft comminution and secure reconstruction of the greater tuberosity and posterior cuff around the humeral stem, in order to preserve active external rotation.
The surgical technique described hereinafter is performed through the deltopectoral approach. The humeral component is cemented, and the position of the stem is assessed intraoperatively by means of an extramedullary jig. The subscapularis is not repaired to avoid excessive tension of the anterior soft tissues, a condition that could hinder recovery of external rotation.
After surgery, the arm is kept in a sling for 1 month. Assisted passive mobilization of the shoulder is started at 2 weeks, and active movements are encouraged at 3 weeks.
KeywordsReverse shoulder arthroplasty Proximal humerus fracture Deltopectoral Transdeltoid Humeral tuberosity
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