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J Shoulder Elbow Surg. 2015 Nov;24(11):e299-306. doi: 10.1016/j.jse.2015.04.014. Epub 2015 Jul 2.

Tuberosity healing after reverse shoulder arthroplasty for acute proximal humerus fractures: the "black and tan" technique.

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Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA.
Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA. Electronic address:
Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA; Holy Cross Orthopedic Research Institute, Fort Lauderdale, FL, USA.



Reverse shoulder arthroplasty has seen increased use for management of complex proximal humeral fractures in the elderly. Recent evidence has shown that tuberosity healing leads to improved active range of motion and functional outcomes. The purpose of this study was to report on the radiographic and clinical outcomes of a consecutive series of patients having undergone reverse shoulder arthroplasty for fracture utilizing the "black and tan" method--a hybrid cementation-impaction grafting technique that uses autogenous cancellous bone graft to create an interface between the proximal cement mantle and the area of tuberosity repair.


Twenty-five patients (average age, 77 years; range, 63-88 years) were included in the analysis with a mean follow-up of 17 months. All patients underwent reverse shoulder arthroplasty for a complex proximal humerus fracture using the black and tan technique.


The tuberosity healing rate was 88%. At final follow-up, mean active elevation was 117° ± 23°, mean abduction was 86° ± 16°, and mean external rotation was 29° ± 18°. External rotation strength averaged 4.9 ± 0.2. The Simple Shoulder Test and Single Assessment Numeric Evaluation scores averaged 7 and 76, respectively. The mean American Shoulder and Elbow Surgeons total score was 71; visual analog scale score for pain, 2; and visual analog scale score for function, 7. Of the 25 patients, 21 (84%) rated their satisfaction with the surgery as excellent or good.


The black and tan technique together with standard suture repair and an implant with features that support tuberosity repair results in a high tuberosity healing rate with restoration of external rotation after reverse shoulder arthroplasty for fracture.


Reverse shoulder arthroplasty; black and tan; proximal humerus fracture; tuberosity healing

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