Journal of Clinical Medicine
It’s Better to Start with a Hug: Technique for Reverse Shoulder Arthroplasty for Three- and Four-Part Proximal Humeral Fractures
By Francesco Franceschi, Matteo La Verde, Luca Saccone and 6 others.
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.