Reverse Total Shoulder Arthroplasty After Proximal Humerus Fracture Using a Novel FiberTape Cerclage Tuberosity Fixation Technique.

Abstract

An 82-year-old woman presenting with an acute, 4-part proximal humerus fracture-dislocation after a ground-level fall was treated with reverse total shoulder arthroplasty using a novel FiberTape cerclage tuberosity fixation technique. Surgery was done within 24 hours of injury using a deltopectoral approach. The reconstruction technique incorporated a standard metaphyseal press-fit stem, autologous bone graft, and a modified Six-Tec-based suture tuberosity repair combined with a tension-band construct derived from a prophylactic humeral shaft FiberTape cerclage (Arthrex) anchored distal to fracture. The patient progressed from shoulder pendulums and active-assisted forward elevation in the scapular plane immediately postoperative to active range of motion at 6 weeks and removal of all restriction at 12 weeks. Simple Shoulder Test and QuickDASH scores were 10 and 9.09, respectively, at 96 weeks postoperatively with the patient reporting the ability to touch the back of her head and reach her buttock for self-hygiene. Active forward elevation was 140° at 1 year and 140° at 2.4 years with 30 degrees of external rotation. Tuberosity union was achieved by 3 months with minimal displacement. The patient did not experience any postoperative complications such as dislocation, implant failure, periprosthetic fracture, infection, humeral stem lucency, heterotopic ossification, or revision surgery.