case_images: PMC11823865_01
case_images: Stable implant. Radiographs of the right shoulder depicting the absence of implant loosening in (A) the standard anterior-posterior view and (B) the lateral axial view.
case_images: JOCR-15-32-g001.jpg
case_images: PMC11823865_01_JOCR-15-32-g001.jpg
case_images: F1
case_images: Radiographic evaluation showed no signs of implant loosening. (Fig. 1) After discussing with the patient, a secondary pectoralis major (PM) transfer was scheduled, but a few days before the operation, the patient was injured from a slip down in his right shoulder, with a tray-taper breakage seen on radiography and computed tomography scans (Fig. 2a and b).
case_images: Taper-tray breakage. (A) Radiograph of the right shoulder revealing the dissociation [red arrow] of the humeral tray from the prosthesis body. (B) Coronal view of computed tomography of the right shoulder illustrating the breakage of the Taper-Tray component [red arrow] of the prosthesis. (C) Intraoperative image capturing the broken taper tray of the prosthesis.
case_images: JOCR-15-32-g002.jpg
case_images: PMC11823865_01_JOCR-15-32-g002.jpg
case_images: F2
case_images: After preparing the PM tendon (Fig. 3a), the broken tray-taper part of the RTSA was removed, and the humeral component was extracted using a flexible osteotome. (Fig. 2c) The glenoid component showed stable fixation and was left untouched.
case_images: Intraoperative image of the right shoulder. (A) Harvested pectoralis major tendon [white asterisk]. (B) Cemented humeral component of the revision stem [white arrow]. (C) Pre-placed loop sutures [blue arrow] secured in the tendinous portion of the teres minor muscle [blue asterisk]. (D) Attachment of the harvested pectoralis major tendon [white asterisk].
case_images: JOCR-15-32-g003.jpg
case_images: PMC11823865_01_JOCR-15-32-g003.jpg
case_images: F3
case_images: After preparing the PM tendon (Fig. 3a), the broken tray-taper part of the RTSA was removed, and the humeral component was extracted using a flexible osteotome. (Fig. 2c) The glenoid component showed stable fixation and was left untouched. These sutures formed loops, and the fracture-cemented humeral stem (Equinoxe; Exactech, Inc, Gainesville, Florida, USA) was passed through the pre-placed loop suture and impacted into the humerus. (Fig. 3b) Each end of the sutures was passed through the lateral edge of the harvested PM tendon, and the other ends were passed through the teres minor tendon. (Fig. 3c) Finally, these sutures were tied together, ensuring a firm attachment of the PM tendon to the humerus. (Fig. 3d) The patient was immobilized for the first 4 weeks and gradually progressed to an active-assisted range of motion exercises, followed by strengthening exercises at 3 months postoperatively.
case_images: Post-operative image. Radiographs of the right shoulder post-revision indicate that the humeral component of the prosthesis was revised with no observed signs of loosening in (A) the standard anterior-posterior view and (B) the lateral axial view.
case_images: JOCR-15-32-g004.jpg
case_images: PMC11823865_01_JOCR-15-32-g004.jpg
case_images: F4
case_images: Radiographic images showed a securely fixed implant without any signs of loosening (Fig. 4).