Step 1:Position the patient in the semi-beach chair upright position.

Step 2:Use a long deltopectoral approach using the coracoid process as a landmark.The cephalic vein is usually retracted
laterally with the deltoid, but may be retracted medially with pectoralis major.

Step 4:Identify biceps tendon/bicipital groove and its course to aid in identifying both orientations of the lesser and greater
tuberosities.

Step 5:The lesser tuberosity is medial to biceps tendon and the greater is superior,lateral, and posterior to biceps.An osteotome can be used to helpmobilize the tuberosities respectively.Palpate the axillary nerve on anterior /inferior aspect of Subscapularis.

Step 5: (Continued)Mobilize and secure the tuberosities with sutures (Example: 1mm Cottony Dacron) the suture technique is simple(red), mattress (green) and simple (blue)sutures from superior to inferior.

Step 6:Remove humeral head.

Step 8:Hand ream sequentially to appropriate size.

Step 9:Start with the expandable trial that is 2mm smaller than the last reamer used.

Step 10: (Continued)Place trial humeral head on stem, which most closely matches native humeral head.

Step 10: (Continued)Mark your height with the 3 laser lines and version with electrocautery on the humeral shaft.

Step 10: (Continued)Tighten the T-Handle (approximately half a turn) to lock the expanded trial into the distal humerus at appropriate height and version.

Step 11:To establish reduction:Begin by placing the humeral head trial on the expandable trial.Reduce humeral head into glenoid.Check for 50% translation of humeral head on glenoid.

Step 12:To check version, flex the elbow 90°,externally rotate until the prosthesis is in the neutral position. The forearm should be externally rotated approximately 30°.

Step 12:When the forearm is parallel to the version rod, the expandable trial is in 30° of retroversion.

Step 13: Cement Prosthesis:Hold at appropriate height and version until cement has hardened.

Step 14: Humeral Head-Trial head is replaced on humeral prosthesis.

Step 15: Bone Grafting-For grafting, place the native humeral
head onto bone graft tray that corresponds with chosen expandable trial.

Step 15: Tuberosity Repair/Bone Grafting-Keep prepared bone graft on back table. Superior simple tuberosity sutures (red) are placed through the prosthesis and then through one another respectively.The inferior simple tuberosity sutures
are passed at the bone tendon junction through one another as well (blue).

Step 15: Tuberosity Repair/Bone Grafting-Insert the previously molded bone graft into the implant fenestration.

Step 15: (Continued)Simple tuberosity sutures (red, blue) are
tied first, then mattress sutures (green)are tied for tuberosity-to-tuberosity repair.

Step 15: (Continued)Tuberosity sutures are then tied to shaft sutures for tuberosity to shaft repair.

Depth Markers---The above graphic shows the difference in height for the depth markers from size to size.
> Size 7 is unique to itself
> Sizes 8 through 13 share the same depth marking pattern
> Sizes 14 and 15 share the same depth marking pattern

 ReUnion Fracture System - Expandable Stem Trial

 ReUnion HA Fracture System

 ReUnion Shoulder Fracture Components

 ReUnion Shoulder Stem