In this case a total shoulder replacement was performed, despite the proximal humeral deformity due to the malunion. The patient had an intact rotator cuff on the MRI and was very active with preoperative shoulder active forward elevation to greater than 140 degrees. The superimposed MRI on the postoperative Grashey X-ray is an alternative method of assessing the position of the humeral head, because the landmarks are changed due to the proximal humerus deformity. (see last image of this post)
