Pass the tuberosity cables through the corresponding holes in the prosthesis. enlarge

Insert cables

Pass the tuberosity cables through the corresponding holes in the prosthesis.


Drill two 2.0 mm holes through the lesser tuberosity and pass the cables through them. enlarge

Fix the lesser tuberosity

Drill two 2.0 mm holes through the lesser tuberosity and pass the cables through them. An appropriate passing device is used, if necessary.


Reduce the glenohumeral joint and preliminarily reduce the tuberosities under the flange of the prosthetic humeral head. enlarge

Glenohumeral reduction and reduction of the tuberosities

Reduce the glenohumeral joint and preliminarily reduce the tuberosities under the flange of the prosthetic humeral head.


Retrieve cancellous bone from the humeral head and pack it beneath the tuberosities. enlarge

Bone grafting

Retrieve cancellous bone from the humeral head and pack it beneath the tuberosities. This will increase the primary stability of the tuberosities, particularly in osteoporotic bone.


Final reduction of the tuberosities enlarge

Final reduction of the tuberosities

By pulling the stay sutures inserted through the subscapularis and the infraspinatus tendons, the tuberosities are reduced beneath the humeral head.


Final reduction of the tuberosities enlarge

Then tighten the stay sutures and tie them securely.


After preliminary fixation of the reduced tuberosities, the reduction has to be confirmed by visual, tactile, and x-ray control. enlarge

Confirmation of reduction

After preliminary fixation of the reduced tuberosities, the reduction has to be confirmed by visual, tactile, and x-ray control.

Visual control
There should be no gap and no step-off between the tuberosities underneath the humeral head prosthesis. The tuberosities must be under the humeral head.


The inferior spike of the greater tuberosity should fit snugly into the fracture gap. This would be revealed by visual control. enlarge

The inferior spike of the greater tuberosity should fit snugly into the fracture gap. This would be revealed by visual control.


Close the supraspinatus split with a running suture. enlarge

Close the supraspinatus split

Close the supraspinatus split with a running suture.