"Two-Step Shish Kebab": A Useful Technique for Reverse Shoulder Arthroplasty in Humeral Surgical Neck Non-unions

The treatment of surgical neck non-unions of the proximal humerus presents significant challenges, with reverse shoulder arthroplasty emerging as a treatment option. During this procedure, avoiding tuberosity osteotomies is crucial to optimizing functional outcomes and minimizing complications. We introduce the "two-step shish kebab" method, a useful technique where the metaphyseal and tuberosity segments of the proximal humerus are percutaneously reduced and transfixed with a modified Steinmann pin before performing the deltopectoral approach. This pin is subsequently replaced by the humeral stem of the prosthesis, which is inserted directly through the proximal fragment and into the medullary canal, eliminating the need for tuberosity osteotomy. This technique offers an elegant solution to the technical challenges associated with type 3 fracture sequelae.