Hemiarthroplasty for Fracture Design Rationale and Surgical Technique Reza Omid, M.D. Assistant Professor Orthopaedic Surgery Shoulder & Elbow Reconstruction.

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Presentation transcript:

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) Integra (Consultant) DeRoyal (Consultant)

Optimal Treatment UNKOWN???? JSES 2011: (RCT ORIF vs Non-op) JSES 2011: (RCT ORIF vs Non-op JSES 2011: (RCT Hemi vs Non-op) JOT 2011 (RCT ORIF vs Non-op)

Hemiarthroplasty Older Patients Osteopenic Bone Fracture-Dislocations – > 40% Impression Defect

Hemiarthroplasty Technique

Patient Position

Surgical Technique Extended deltopectoral exposure: deltoid origin and insertion intact

Proximal Humerus Fracture Parts

Surgical Technique Identify the LHB and Tuberosities Evaluate the rotator cuff injury

Surgical Technique Remove the humeral head Evaluate the glenoid

Tuberosity Suture Technique Place suture at the tendon bone interface

Head Size Solutions –removed head is guide »thickness > radius –error towards undersize –check gross appearance

Position of Greater Tuberosity Height Relative to Humeral Head

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

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

Head SizeSpherical Ø 38x14*41 40x15*43 42x x x x x x x x x x x x2055 *Eccentric Only Press-fit Stems Primary Proximal Bodies Head Options Small Standard Large Glenoid Options ***Any size primary or fracture body can be used with any size press fit or cemented stem

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

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

Determining Height

Proximal Humerus Fracture

Humeral Version

Version Effect of Incorrect Version Too Anteverted Too Retroverted

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

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

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

Surgical Technique

4 Part Fracture Repair

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

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

Thank You