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Contemporary cementing techniques aim to improve cement penetration into bone, resulting in increased initial fixation strength, a more enduring micro-interlock fixation and reduced failure by aseptic loosening.1 Intramedullary plugging is integral to this and in humeral preparation prevents cement migration towards the shoulder, which may hinder future surgery. Several humeral plugs have been described.2–4 The humeral canal lumen is, however, narrowest distally and insertion of an introducer can compromise this canal. We believe that the Hardinge Cement Restrictor (DePuy UK, Leeds, UK) is in popular use but have found the bulky size of the Hardinge introducer problematic.
We describe a technique of introducing the Hardinge Cement Restrictor into the humeral canal on a readily available and cheap 2.0-mm threaded guide wire. The flanges of the restrictor are trimmed to the appropriate size then threaded onto the guide wire producing a secure construct for insertion (Fig. 1). Once inserted at the correct level, the wire is unscrewed and removed, leaving the restrictor in situ.
The Hardinge Cement Restrictor is familiar to most orthopaedic surgeons and benefits from being on-hand in most orthopaedic units. However, the differences in humeral and femoral anatomy make the use of the Hardinge introducer a threat to the integrity of the bone. The use of a 2.0-mm threaded guide wire produces a sound, safe and accessible construct for the insertion of the cement restrictor. In our experience, migration of the restrictor has not been observed. Figure 2 demonstrates the device's efficacy.