title: Tuberosity healing after reverse shoulder arthroplasty for acute proximal humerus fractures: the "black and tan" technique.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA.
authors.forename: Nathan T
authors.initials: NT
authors.lastname: Formaini
authors.affiliation: Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA.
authors.forename: Nathan G
authors.initials: NG
authors.lastname: Everding
authors.affiliation: Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA. Electronic address: jonlevy123@yahoo.com.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Levy
authors.affiliation: Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA; Holy Cross Orthopedic Research Institute, Fort Lauderdale, FL, USA.
authors.forename: Sam
authors.initials: S
authors.lastname: Rosas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000379:methods*; D001843:Bone Cements / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D017102:Fracture Healing; D006801:Humans; D006811:Humerus / Q000637:transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012784:Shoulder Fractures / Q000601:surgery*; D012785:Shoulder Joint / Q000601:surgery*; D064232:Visual Analog Scale
chemical_list: D001843:Bone Cements
keywords: Reverse shoulder arthroplasty; black and tan; proximal humerus fracture; tuberosity healing