AANA Lab Course 906- Técnicas Avanzadas de Cirugía de Hombro-Artroplastia invertida en fracturas-Joaquin Sánchez-Sotelo, MD, PhD

Artroplastia invertida en fracturas-Joaquin Sánchez-Sotelo, MD, PhD

Pdf Summary

The 2019 Advanced Shoulder Surgery Course presented by Dr. Joaquin Sanchez-Sotelo focuses on the use of reverse shoulder arthroplasty (RSA) for proximal humerus fractures. Certain proximal humerus fractures cause such extensive damage that joint replacement is the only viable treatment. Today, reverse shoulder prostheses are preferred over partial anatomic ones for these fractures.<br /><br />A critical technical consideration is the reconstruction of the tuberosities; successful healing reduces the risk of dislocation and improves functional outcomes, especially active external rotation.<br /><br />Indications for RSA include fractures with substantial articular cartilage destruction or compromised blood supply to the humeral head, such as fracture-dislocations or fractures involving over 40% of the humeral head, particularly in elderly patients. Additionally, severe surgical neck fractures with significant metaphyseal comminution or osteoporosis, especially when the tuberosities are fractured, may also require RSA.<br /><br />Surgically, both the deltopectoral and superior approaches are acceptable. The long head of the biceps tendon is tenodesed, and both tuberosities are carefully controlled with sutures. The fractured humeral head is removed and saved for grafting. Glenoid component placement emphasizes minimal reaming, inferior tilt aligned with the glenoid edge, and minimal lateralization. Trial humeral components help determine size, height, and typically 20 degrees of retroversion. The humeral stem is cemented, incorporating graft onto the fractured diaphysis. Tuberosities are fixed with a combination of horizontal and vertical sutures.<br /><br />Postoperative care involves immobilization with some external rotation for six weeks, followed by a phased physiotherapy regimen beginning at six weeks with passive and assisted active mobilization. Isometric exercises start around week 10, progressing to elastic band exercises by week 12, continuing for three months or longer. Full functional recovery and mobility range may take a year or more.

Keywords

Reverse Shoulder Arthroplasty

Proximal Humerus Fractures

Tuberosity Reconstruction

Deltopectoral Approach

Superior Approach

Postoperative Rehabilitation

Humeral Head Grafting

Glenoid Component Placement

External Rotation Recovery

Elderly Shoulder Fractures