Case Study

Integra® Total Shoulder Arthroplasty

Press-fit Reverse Total Shoulder Arthroplasty for Comminuted Proximal Humerus Fracture

Patient Profile/HistoryThe patient is a 73 year old female who suffered a mechanical fall onto her right upper extremity. She was seen in the emergency room on the date of injury where x-rays confirmed a comminuted and displaced right proximal humerus fracture. She was placed in a sling and was subsequently referred for definitive management. Review of the outside x-rays confirmed a four-part proximal humerus fracture with displacement of both tuberosities and dislocation of the articular fragment. The patient had significant swelling and ecchymosis about the shoulder and pain and crepitation with attempted range of motion. She had intact axillary sensation and demonstrated active deltoid function. Options for management were discussed at length with the family and it was felt that the patient would be optimally managed with reverse total shoulder arthroplasty. She underwent medical evaluation and clearance and was scheduled for surgery.

Surgical TreatmentThe patient was taken to the operating room and under combination regional and general anesthesia was placed in a low beachchair position. A standard deltopectoral approach was utilized. The biceps tendon was identified distally and utilized to define the interval between the greater and lesser tuberosity fragments. The articular fragment was completely devascularized and was removed. The greater and lesser tuberosity fragments were tagged with trans-osseous sutures incorporating the rotator cuff and were retracted to expose the glenoid. The biceps tendon and labrum were excised and the Integra® Titan™ Reverse Baseplate was inserted in standard fashion. A 5mm offset eccentric glenosphere was selected and impacted into the morse taper controlling for orientation to maximize inferior offset.

Attention was returned to the humerus. The humeral canal was sequentially impacted until a stable press-fit was achieved with the Integra Titan trial stem. Trial reduction was then carried out to select the appropriate body height to restore soft tissue tension and allow anatomic reduction of the tuberosities. The final implant was assembled and inserted with excellent press-fit diaphyseal purchase and trial reduction carried out to select the optimal height polyethylene liner. The tuberosities were then reduced anatomically and secured to the reverse body by passing the trans-osseous/trans-tendonous sutures through the suture holes in the reverse body fins. The final reconstruction was stable.

Physician ProfileRichard S. Moore, Jr., MD

Hand, Upper Extremity & Microvascular Surgery EmergeOrtho

Wilmington, NC

Board Certification:Board Certified ABOS

Certificate of Added Qualification in Hand Surgery

Medical School:University of North Carolina School of Medicine

Chapel Hill, NC

Residency:Hospital of the University of Pennsylvania

Philadelphia, PA

Fellowship:Hand, Upper Extremity & Microvascular Surgery

Duke University Medical Center Durham, NC

Integra®

Titan™ Reverse Shoulder System

USA 800-654-2873 n 888-980-7742 faxInternational +1 609-936-5400 n +1 609-750-4259 faxintegralife.com/contact

United States, Canada, Asia, Pacific, Latin America

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Pre-Op and Post-Op Radiograph/MRI/CT Images and Surgical Pictures

The Integra® Titan™ Reverse Shoulder System demonstrated unique advantages in the management of this patient’s complex fracture. The press-fit stem allowed for stable fixation of the prosthesis without the need for cement. The modularity of the humeral component allowed selection of the most appropriate body height to optimize soft tissue tension and to allow an anatomic and stable reduction of the tuberosities.

Physician Conclusion

Figure 3:RSA – Intra-Op • Press fit stem • Body height selected for optimal GT reduction

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Figure 1 & 2:73 yo Female presents post fall

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Figure 7:Post-Op – 4 months

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Pre-Op: Intra-Op:

Post-Op:

Figure 4, 5 & 6:Post-Op – 4 monthsUnion of tuberosities in anatomic position

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