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Orthopedic Services
Glendale Adventist Medical Center
1509 Wilson Terrace
Glendale, CA 91206
Ph: (818) 409-8000

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Our 78-year-old "Nana" fell and broke her right shoulder into three pieces. Her surgeon says she needs an operation he can't do, so we are being referred to a special clinic for a reverse shoulder replacement. What's so difficult about this operation?

When it comes to complex fractures of the humerus (upper arm) in older adults, surgeons really have their work cut out for them. There are so many things to keep in mind. A "complex" fracture usually means the bone is broken into three or four parts. Putting the pieces back together in a way that promotes recovery and return to full function can be a real challenge. And the techniques used have been changing over the last 30 years. A very well-known surgeon (Dr. Charles Neer) introduced the idea of replacing the shoulder instead of trying to repair it. That was back in 1970. Since then, surgeons have tried full joint replacement and hemiarthroplasty (replacing only one side of the joint). These methods have proven to work but not always smoothly. Ischemia (loss of blood) and osteonecrosis (death of bone) are major concerns. Pain relief and improvement in function and recovery aren't always guaranteed. So, experts have gone back to the drawing board to rethink surgical treatment for these complex proximal humeral fractures. Proximal means the break occurred at the top of the shoulder where the round head and of the femur are located. They asked themselves if the results could be improved with better surgical technique. That brings us to the latest efforts in this area -- the use of reverse shoulder arthroplasty for three- and four-part proximal humeral fractures. The broken pieces are removed and replaced with a prosthesis (artificial joint). In the "normal" shoulder replacement, the socket side of the implant is a shallow plastic piece and the humeral component is a metal stem attached to a metal ball. In the reverse shoulder replacement, the ball and the socket are reversed. The use of reverse shoulder replacements requires highly technical skills on the part of the surgeon. There's little room for error. Specialized training is required to perform this procedure and surgeons must be in a setting where they are able to perform the operation on more than just an occasional patient. Your surgeon is wise in referring your Nana to someone who has this advanced training.


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