Executive Editor: Peter Trafton

Authors: Martin Jaeger, Frankie Leung, Wilson Li

Proximal humerus Isolated anatomical neck, dislocation

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1 Principles top


Key to successful arthroplasty

  • Exposure of the shoulder joint. In these fractures, the tuberosities are not fractured and the humeral head is dislocated in isolation. Therefore, the approach to the glenohumeral joint is completely different. Depending on the surgeon’s preference, an osteotomy of the lesser tuberosity or a tenotomy of the subscapularis tendon may be used. However, an osteotomy of the lesser tuberosity is recommended.
  • Correct determination of the surgical landmarks
  • Proper determination of prosthesis size and position

2 Treatment top


The implantation of a hemiarthroplasty in these fractures is comparable to hemiarthroplasty in degenerative arthrosis.

Key steps are:

  • Retrieval of humeral head
  • Measurement of humeral head size
  • Exposure of proximal humerus in external rotation and adduction
  • Exposure of most medial insertion line of supraspinatus tendon
  • Rasping of humeral shaft
  • Probe insertion
  • Trimming of anatomic neck using oscillating saw and using probe as a template
  • Defining final size and position of prosthetic humeral head
  • Assembly of prosthesis according to individual parameters
  • Insertion of definitive prosthesis
  • Closure of osteotomy/tenotomy

These fractures are rare. Therefore, the surgical procedure of this treatment is not detailed here. Please refer to the manufacturer’s technique guide.

v2.0 2011-05-02