Basic technique – uncemented stem

Provisional reduction of the fracture may be provided by cerclage wire or sutures.

The appropriate plate for fixation may be applied and provisionally fixed proximally and distally, taking care not to obstruct the implantation of a planned humeral component. Provisional monocortical screws are recommended.

Pearl: Preoperative planning is needed to determine where the tip of the humeral implant will reach, so that adequate plate length and screw distribution is achieved distal to the new implant.

The canal is prepared using manual reamers of increasing size, until an appropriate diaphyseal fit distal to the fracture is obtained.

Pitfall: Excessive torsion may disrupt the provisional fracture fixation. This can be avoided by incremental increase in the size of the reamers, and by taking care not to advance the reamer while applying torque.

$Humeral shaft periprosthetic fracture – the canal is prepared$

Pitfall: If fracture fixation has been performed, ensure that the reamer does not engage with the unicortical screws during canal preparation.

In the case of reamer engagement with the screws, the following options can be considered:

Replace the screw with a shorter screw, or a screw with a blunt tip.
Downsize the diameter of the humeral component.

Pitfall: The diameter of the humeral component must be sufficient to gain primary stability distal to the fracture.

$Humeral shaft periprosthetic fracture – ensure that the reamer does not engage with the unicortical screws during canal preparation$

A trial component is inserted.

The shoulder joint is reduced. Stability is assessed.

It may be difficult to assess joint stability if the trial is not stable in bone.

per 10 X150 Basic technique uncemented stem

The shoulder is then dislocated, and the trial component is removed.

Pitfall: Care must be taken during dislocation not to disrupt the fracture fixation.

Pearl: A clamp supporting the fixation is helpful during dislocation.

$Humeral shaft periprosthetic fracture – the trial component is removed$

Implantation of humeral component

The definitive implant is inserted slowly. Longitudinal and rotational alignment is assessed and corrected before definitive distal impaction.

The definitive implant is relocated. Definitive fracture fixation is completed, and appropriate soft-tissue repairs undertaken. The stability of the joint is assessed, and postoperative aftercare planned accordingly.