Shoulder arthroplasty for post-fracture deformity in the presence of a locking plate

Yesterday our OR schedule included two very active ladies who had the following features in common (1) ORIF with a locking plate,  (2) post-fixation collapse of the humeral head, and (3) extremely stiff painful shoulders. Our desire is to avoid stress risers that might predispose the shaft to fracture as they resumed their heli-skiing and other activities.
Our approach was to retain the plate, removing and/or shortening screws as necessary for insertion of the stem of the humeral component and to use impaction grafting rather than cement to fix the prosthetic stem.
Here are the preop and post op films from the first case

And from the second case

These cases demonstrate the versatility of impaction grafting in minimizing the risk of periprosthetic fratures.

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