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Hemiarthroplasty for Fracture Design Rationale and Surgical Technique

Hemiarthroplasty for Fracture Design Rationale and Surgical Technique. Reza Omid, M.D. Assistant Professor Orthopaedic Surgery Shoulder & Elbow Reconstruction Sports Medicine Keck School of Medicine of USC. Disclosures. JBJSAm (Editorial Board) Smith & Nephew (Consultant)

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Hemiarthroplasty for Fracture Design Rationale and Surgical Technique

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  1. Hemiarthroplasty for Fracture Design Rationale and Surgical Technique Reza Omid, M.D. Assistant Professor Orthopaedic Surgery Shoulder & Elbow Reconstruction Sports Medicine Keck School of Medicine of USC

  2. Disclosures • JBJSAm (Editorial Board) • Smith & Nephew (Consultant) • Integra (Consultant) • DeRoyal (Consultant)

  3. Optimal Treatment • UNKOWN???? • JSES 2011: 1118-1124 (RCT ORIF vs Non-op) • JSES 2011: 747-55 (RCT ORIF vs Non-op • JSES 2011: 1025-1033 (RCT Hemi vs Non-op) • JOT 2011 (RCT ORIF vs Non-op)

  4. Hemiarthroplasty • Older Patients • Osteopenic Bone • Fracture-Dislocations • > 40% Impression Defect

  5. Hemiarthroplasty Technique

  6. Patient Position

  7. Surgical Technique • Extended deltopectoral exposure: deltoid origin and insertion intact

  8. Proximal Humerus Fracture Parts

  9. Surgical Technique • Identify the LHB and Tuberosities • Evaluate the rotator cuff injury

  10. Surgical Technique • Remove the humeral head • Evaluate the glenoid

  11. Tuberosity Suture Technique • Place suture at the tendon bone interface

  12. Head Size • Solutions • removed head is guide • thickness > radius • error towards undersize • check gross appearance

  13. Position of Greater Tuberosity • Height Relative to Humeral Head

  14. Surgical Technique • Assess the humeral height and version • Trial tuberosity reduction • Mark the stem position • 5-8 mm • Height of • the Greater • Tuberosity • Lesser • Tuberosity

  15. Benefits of Titan System • Press fit fracture • No jig needed for stabilizing trials • Varying body heights to dial in correct humeral head height

  16. Primary Proximal Bodies • Glenoid Options • Small • Head Options • Standard • ***Any size primary or fracture body • can be used with any size • press fit or cemented stem • Large • Press-fit Stems • *Eccentric Only

  17. Tuberosity Height = Prosthetic Height • 5-8 mm • Height of • the Greater • Tuberosity • Lesser • Tuberosity

  18. Determining Height • Superior border of Pectoralis tendon (5.6cm±0.5cm) • Side to Side comparison (x-ray) • View calcar contour (gothic arch)

  19. Determining Height

  20. Proximal Humerus Fracture

  21. Humeral Version

  22. Version • Too Anteverted • Too Retroverted • Effect of Incorrect Version

  23. Biceps Groove Version • Groove shifts medially from proximal to distal, changing retroversion values 15.9° from the upper to lower part of the bicipital groove

  24. Surgical Technique • Prepare the fixation sutures for ORIF of the tuberosities. • 2-3 vertical and 2 horizontals, one medial one lateral

  25. Surgical Technique • Tuberosity fixation and bone graft • Biceps tenodesis • Wound drains and closure

  26. Surgical Technique

  27. 4 Part Fracture Repair

  28. Factors Affecting Outcome • Bone density • Rotator cuff tissue quality • Tuberosity healing • Restoration of anatomic humeral head height • Restoration of anatomic humeral version • Rehabilitation

  29. Reverse for Fracture • Age >70-75 (I will consider for age >65) • Tuberosities heal more predictably and function is not as dependent on tuberosity healing • More predictable outcome than with hemi • Best outcome of a hemi is better than best outcome of a reverse

  30. Thank You

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