It’s Better to Start with a Hug: Technique for Reverse Shoulder Arthroplasty for Three- and Four-Part Proximal Humeral Fractures

Background: Reverse shoulder arthroplasty (RSA) is increasingly employed for managing complex three- and four-part proximal humeral fractures (PHFs) in elderly patients. Tuberosity healing and implant stability remain critical challenges, particularly in uncemented RSA. We describe a novel surgical technique—the “Hug Technique” for uncemented RSA in acute three- and four-part PHFs, designed to preserve metaphyseal bone stock, avoid tuberosity osteotomy, and optimize tuberosity healing. Additionally, we evaluated the functional outcomes of our novel surgical technique. Methods: A single-center retrospective cohort study was conducted on patients treated with the “Hug Technique” between January 2023 and January 2025. Inclusion criteria were acute displaced three- or four-part PHFs, age > 65 years, intact deltoid function, and ≥12 months of follow-up. All procedures were performed by a single surgeon using a standardized reverse shoulder implant. Clinical outcomes, functional scores, radiographic findings, complications, and implant survivorship were assessed. Results: A total of 14 patients were included, with a mean age of 74.8 years and a mean follow-up of 14.2 months. At final follow-up, the mean postoperative Constant score was 68.4, and the mean ASES score was 81.6. Mean active forward flexion reached 132°, external rotation 28°, and internal rotation reached the L3 vertebral level in most patients. Anatomical or consolidated tuberosity healing was observed in 78.5% of cases. No cases of stem loosening were observed. Complications occurred in 2 patients, including one case of deep periprosthetic infection and one case of anterior dislocation. Conclusions: The “Hug Technique” represents a feasible surgical strategy for cementless RSA in complex PHFs. Preliminary clinical and radiographic results appear promising. Further prospective comparative studies are required.