Yesterday's cases provide some useful examples.
Here are the x-rays of a man who came to us with a painful shoulder after a prior arthroplasty. The problem is apparent, the surgeon could not fully seat the component because of a too-tight diaphyseal fit. Driving it down further would have risked a fracture. Additional reaming would have weakened the bone. The decision was made to leave it too high.
impaction grafting because it enables us to fit the humerus to the prosthesis (much as Procrustes fit his guests to his bed).
To start, we recognize that the humeral canal dimensions do not conform to any prosthesis.
Selective placement of the graft, enables us to fine tune the position of the prosthesis in the bone, noting the tendency to angle the prosthetic stem in varus and with the proximal end too anterior.
Case I - Total Shoulder
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