Pass the tuberosity cables through the corresponding holes in the prosthesis.
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.
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. This will increase the primary stability of the tuberosities, particularly in osteoporotic bone.
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.
Then tighten the stay sutures and tie them securely.
Confirmation of reduction
After preliminary fixation of the reduced tuberosities, the reduction has to be confirmed by visual, tactile, and x-ray 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.
Close the supraspinatus split
Close the supraspinatus split with a running suture.