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FIGURE 1. A, Preoperative anteroposterior (AP) radiograph of right shoulder with 4-part fracture. B, Preoperative 3 dimensional
computed tomographic scan of the same right shoulder. C, Postoperative AP radiograph after hemiarthroplasty performed for
fracture.
From the Department of Orthopedic Surgery, Stanford University, Redwood City, CA.
The author declares no conflict of interest.
Reprints: Emilie Cheung, MD, Department of Orthopedic Surgery, Stanford University, Redwood City 94063, CA (e-mail: evcheung@stanford.edu).
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110 | www.shoulderelbowsurgery.com Techniques in Shoulder & Elbow Surgery Volume 17, Number 3, September 2016
SURGICAL TECHNIQUE
Patient is placed into the modified beach chair position,
with the waist at 45 degrees of flexion. The shoulder down to
the fingertips is prepped and draped in the usual sterile manner.
The arm is placed into an arm holder. An impervious surgical
drape is applied.
FIGURE 2. Deltopectoral approach for a left shoulder for Intraoperative fluoroscopy may be utilized while per-
proximal humeral fracture. The biceps tendon is identified forming hemiarthroplasty for assessing implant alignment and
underneath the scissors. tuberosity reduction. It is important during set-up, and before
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Cheung Techniques in Shoulder & Elbow Surgery Volume 17, Number 3, September 2016
FIGURE 4. A, Bone graft “cookie cutter” which removes cancellous bone from the humeral head autograft. B, Fracture stem for
hemiarthroplasty, with bone graft placed within the metphysis.
sterile draping, to be able to get the fluoroscopy C-arm unit A standard deltopectoral approach is utilized. The ceph-
into the shoulder region for a proper anterior-posterior view of alic vein is retracted laterally or medially depending on sur-
the glenohumeral joint, as well as a good axillary view. It is in geon preference, and protected. Next, the subacromial-
our routine practice to bring the C-arm in from the contra-
lateral side. The television monitor for the C-arm is positioned
toward the foot of the operating room table.
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Cheung Techniques in Shoulder & Elbow Surgery Volume 17, Number 3, September 2016
FIGURE 8. A, Illustration showing tagging of the supraspinatus/infraspinatus/greater tuborisity, and the suture placed along drill holes placed
within the humeral shaft. With permission from Nho et al18 (http://dx.doi.org/10.2106/JBJS.G.00648). B, The greater tuberosity is secured
around the stem, and to the shaft. C, The lesser tuberosity is secured around the stem. D, The final suture construct around the implant.
Postoperative Protocol 3. Anjum SN, Butt MS. Treatment of comminuted proximal humerus
On postoperative day number 1, the patients are taught fractures with shoulder hemiarthroplasty in elderly patients. Acta
pendulum exercises for the shoulder. Active range of motion is Orthop Belg. 2005;71:388–395.
allowed for elbow, wrist, and hand. No active range of motion 4. Boileau P, Krishnan SG, Tinsi L, et al. Tuberosity malposition and
is allowed until 6 weeks postoperative, to allow for adequate migration: reasons for poor outcomes after hemiarthroplasty for dis-
tuberosity healing. Strengthening is started at 3 months post- placed fractures of the proximal humerus. J Shoulder Elb Surg. 2002;
operative. Patients are educated that the majority of their 11:401–412.
motion improves at 3 to 6 months postoperative, and their final
motion may take a year to achieve (Figs. 1–8). 5. Antuña SA, Sperling JW, Cofield RH. Shoulder hemiarthroplasty for
acute fractures of the proximal humerus: a minimum five-year follow-
up. J Shoulder Elb Surg. 2008;17:202–209.
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