While some surgeons are interested in short stemmed humeral prostheses, these prostheses carry a risk of stress shielding (see here) if the distal end of the implant is wedged in the diaphysis, as seen below.
Another consequence of a wedged short stem is periprosthetic fracture as shown by a case that presented to us this week (x-rays below)
For these reasons we continue to prefer a standard length stem inserted without endosteal reaming or broaching and with impaction grafting (see below), so that the distal end of the prosthesis is not wedged in the diaphysis. This approach is intended to minimize the risk of stress shielding and periprosthetic fracture.
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