Custom 3D Printed Jigs in Salvage Reverse Shoulder Arthroplasty for Failed Four-Part Proximal Humerus Fracture...

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• 3D Printing in Medicine

Background:

• Complications of open reduction and internal fixation (ORIF) for four-part proximal humerus fractures (PHFs) include non-union, malunion, and avascular necrosis.
• Reverse total shoulder arthroplasty (RTSA) serves as a salvage procedure for failed ORIF.
• Patient-specific 3D printed jigs are crucial for pre-operative planning in RTSA, particularly with abnormal glenoid anatomy.

Observation:

• A 58-year-old female with bilateral PHF treated with ORIF experienced right-sided non-union with glenoid erosion.
• Salvage RTSA was planned, but an iatrogenic glenoid fracture occurred during initial drilling.
• After conservative management and union of the iatrogenic fracture, RTSA was successfully performed using custom 3D printed jigs.

Findings:

• The use of custom 3D printed jigs facilitated accurate positioning of the glenoid component in a case with a small glenoid and posterior defect.
• The patient achieved significant functional recovery, with active forward elevation of 110°, lateral elevation of 90°, and external rotation of 10° at 1-year follow-up.
• 3D bone models also aided in appropriate implant selection for the complex case.

Implications:

• RTSA is a viable salvage option for failed proximal humerus fracture fixation, offering predictable outcomes.
• Custom-made, patient-specific 3D printed jigs enhance the precision of RTSA, especially in challenging cases with glenoid abnormalities.
• This technology improves pre-operative planning and surgical execution, leading to better functional results in shoulder arthroplasty.