# Reverse Total Shoulder Arthroplasty for Proximal Humerus Nonunion

## TL;DR

This paper presents a new RTSA technique for treating shoulder fractures in elderly patients that preserves the tuberosities to improve joint stability and function.

## Contribution

A reproducible RTSA technique that preserves and repairs tuberosities to enhance stability and outcomes in proximal humerus nonunions.

## Key findings

- The patient regained pre-injury function with pain-free forward elevation to 110 degrees.
- Radiographic evidence showed maintained tuberosity reduction and healing with no instability.
- Tuberosity preservation may reduce dislocation risk and improve recovery in elderly patients.

## Abstract

Background: Surgical neck nonunions of the proximal humerus present a complex clinical challenge, especially in elderly patients with pre-existing glenohumeral arthritis. Reverse total shoulder arthroplasty (RTSA) offers a reliable treatment option in these cases; however, resection of the tuberosities may compromise joint stability, increase the risk of postoperative dislocation and compromise postoperative function. This article describes a reproducible RTSA technique that preserves and repairs the greater and lesser tuberosities, aiming to enhance construct stability and optimize outcomes. Methods: We present a 74-year-old female with underlying glenohumeral arthritis who underwent RTSA for a symptomatic surgical neck nonunion via an extended deltopectoral approach. The nonunion is first mobilized, and tuberosity osteotomies are performed. After implant placement, the tuberosities are secured to the implant, to each other, and to the humeral shaft. A cerclage suture is also passed circumferentially to reinforce the repair and prevent posterior gapping. Results: The patient regained her pre-injury level of function by her last follow-up. She had pain-free, active forward elevation to 110 degrees and radiographic evidence of maintained tuberosity reduction and healing. There was no evidence of instability. Conclusions: In conclusion, incorporating tuberosity preservation and repair into RTSA for proximal humerus nonunion may reduce dislocation risk and improve functional recovery in elderly, low-demand patients.