It’s Better to Start with a Hug: Technique for Reverse Shoulder Arthroplasty for Three- and Four-Part Proximal Humeral Fractures
4 affiliations
- 1Department of Orthopaedic and Trauma Surgery, San Pietro Fatebenefratelli Hospital, 00189 Rome, Italy
- 2Faculty of Medicine and Surgery, Link Campus University, 00165 Rome, Italy
- 3II Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli-DIBINEM, University of Bologna, 40100 Bologna, Italy
- 4Faculty of Medicind and Surgery, IUniCamillus-Saint Camillus International University of Health Sciences, 00131 Rome, Italy
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.
Related
- Beyond scores: Predictable early recovery and independence after reverse shoulder arthroplasty for complex proximal humerus fractures
- Supraspinatus management in reverse total shoulder arthroplasty for proximal humerus fractures: current evidence and practical considerations.
- Conservative Treatment with Adjunctive Use of Teriparatide for Periprosthetic Humeral Fractures after Reverse Total Shoulder Arthroplasty: A Report of 6 Cases
- Staged Revision Reverse Total Shoulder Arthroplasty to Functional Hemiarthroplasty With Retained Humeral Implant: A Salvage Technique
- Early mobilization after reverse total shoulder arthroplasty is not associated with increased risk of acromial and scapular stress fractures: a retrospective cohort study.
BibTeX
@article{franceschi2026better,
title = {{It’s Better to Start with a Hug: Technique for Reverse Shoulder Arthroplasty for Three- and Four-Part Proximal Humeral Fractures}},
author = {Francesco Franceschi and Matteo La Verde and Luca Saccone and Antonio Caldaria and Alice Patrignani and Gian Mauro De Angelis D’Ossat and Luca La Verde and Alessio Palumbo and Angelo Baldari},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15218348},
url = {https://www.mdpi.com/2077-0383/15/21/8348},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - It’s Better to Start with a Hug: Technique for Reverse Shoulder Arthroplasty for Three- and Four-Part Proximal Humeral Fractures
AU - Francesco Franceschi
AU - Matteo La Verde
AU - Luca Saccone
AU - Antonio Caldaria
AU - Alice Patrignani
AU - Gian Mauro De Angelis D’Ossat
AU - Luca La Verde
AU - Alessio Palumbo
AU - Angelo Baldari
PY - 2026
DA - 2026/10/27
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218348
UR - https://www.mdpi.com/2077-0383/15/21/8348
AB - 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.
SN - 2077-0383
ER -