{
  "abstract": "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.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Orthopaedic and Trauma Surgery, San Pietro Fatebenefratelli Hospital, 00189 Rome, Italy",
    "Faculty of Medicine and Surgery, Link Campus University, 00165 Rome, Italy",
    "II Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli-DIBINEM, University of Bologna, 40100 Bologna, Italy",
    "Faculty of Medicind and Surgery, IUniCamillus-Saint Camillus International University of Health Sciences, 00131 Rome, Italy"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Francesco Franceschi"
    },
    {
      "affs": [
        0,
        2
      ],
      "name": "Matteo La Verde"
    },
    {
      "affs": [
        0
      ],
      "name": "Luca Saccone",
      "orcid": "0000-0001-8660-3213"
    },
    {
      "affs": [
        0
      ],
      "name": "Antonio Caldaria"
    },
    {
      "affs": [
        0,
        3
      ],
      "name": "Alice Patrignani",
      "orcid": "0009-0006-5395-6702"
    },
    {
      "affs": [
        0
      ],
      "name": "Gian Mauro De Angelis D’Ossat"
    },
    {
      "affs": [
        0
      ],
      "name": "Luca La Verde",
      "orcid": "0000-0003-0593-8631"
    },
    {
      "affs": [
        0,
        3
      ],
      "name": "Alessio Palumbo"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Angelo Baldari",
      "orcid": "0009-0004-4377-1654"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/d9498d5nqgv98.bib",
  "cited_by": 0,
  "doi": "10.3390/jcm15218348",
  "fulltext_url": null,
  "id": "d9498d5nqgv98",
  "issns": [
    "2077-0383"
  ],
  "landing_url": "https://www.mdpi.com/2077-0383/15/21/8348",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2746|Shoulder Injury and Treatment"
    ]
  ],
  "openalex": "W7223891810",
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-27",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/d9498d5nqgv98.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:01Z",
      "native_id": "10.3390/jcm15218348",
      "source": "crossref",
      "url": "https://www.mdpi.com/2077-0383/15/21/8348"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2746|Shoulder Injury and Treatment",
      "subfield": "surgery"
    }
  ],
  "title": "It’s Better to Start with a Hug: Technique for Reverse Shoulder Arthroplasty for Three- and Four-Part Proximal Humeral Fractures",
  "title_text": "It’s Better to Start with a Hug: Technique for Reverse Shoulder Arthroplasty for Three- and Four-Part Proximal Humeral Fractures",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:01Z",
  "url": "https://research.draconitic.com/paper/d9498d5nqgv98",
  "venue": "Journal of Clinical Medicine",
  "versions": []
}