Avoiding Cement Bone Necrosis Effect on Tuberosity Healing

Tuberosity healing in the setting of shoulder arthroplasty for fracture has been shown to have significant effects on functional shoulder outcomes. Although surgical techniques have been developed to encourage anatomic tuberosity healing, the thermal effects of cement on bone can limit successful healing. The technique described in this manuscript utilizes a bone graft interface between the cement and the tuberosities, which helps create an interface of bone for successful tuberosity healing. Bone graft taken from the humeral head and impacted bone from the intramedullary canal of the humeral shaft is placed as a compressed layer of bone above the cement line, creating a “black-and-tan” interface. This technique can be used with both hemiarthroplasty and reverse shoulder arthroplasty when treating complex proximal humerus fractures.