TechniquesAvoiding Cement Bone Necrosis Effect on Tuberosity Healing The “Black-and-Tan” TechniqueLevy, Jonathan C. MDAuthor Information Holy Cross Orthopedic Institute, Fort Lauderdale, FL Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website, www.shoulderelbowsurgery.com. J.C.L. is a paid consultant for Arthrex, DJO, and Stryker Orthopaedics. He receives royalties for the DJO Monoblock stem illustrated in a figure given in this manuscript. Reprints: Jonathan C. Levy, MD, Holy Cross Orthopedic Institute, 5597 North Dixie Highway, Fort Lauderdale, FL 33334 (e-mail: [email protected]). Techniques in Shoulder & Elbow Surgery: September 2013 - Volume 14 - Issue 3 - p 81-84 doi: 10.1097/01.bte.0000432844.49786.47 Buy SDC Metrics Abstract Tuberosity healing in the setting of shoulder arthroplasty for fracture has been shown to have significant effects on functional shoulder outcomes. Although surgical techniques have been developed to encourage anatomic tuberosity healing, the thermal effects of cement on bone can limit successful healing. The technique described in this manuscript utilizes a bone graft interface between the cement and the tuberosities, which helps create an interface of bone for successful tuberosity healing. Bone graft taken from the humeral head and impacted bone from the intramedullary canal of the humeral shaft is placed as a compressed layer of bone above the cement line, creating a “black-and-tan” interface. This technique can be used with both hemiarthroplasty and reverse shoulder arthroplasty when treating complex proximal humerus fractures. © 2013 by Lippincott Williams & Wilkins, Inc.