Wednesday, January 2, 2013

Humeral fractures after shoulder replacement

Surgically Treated Humeral Shaft Fractures Following Shoulder Arthroplasty

This is a report regarding 36 patients with humeral periprosthetic fractures treated surgically. 19 had loose humeral components and were treated with revision arthroplasty; the remainder were treated with internal fixation leaving the prosthesis in place. 17 had fractures around the humeral component of reverse total shoulders. 16 had severe osteopenia. After treatment 35 had healed in 3 to 14 months. The average ASES score was 50. Fourteen of the surgically managed fractures had complications including prosthesis failure, non union, radial nerve plasy, infection, and prosthesis loosening.

The authors emphasize the need for careful preoperative evaluation and presurgical planning in that a wide variety of surgical techniques were required.

It is of note that many of these fractures appear to have involved the tip of a cemented or press fit prosthesis where an abrupt transition in structural properties of the humerus takes place.

On the one hand we need to explore ways for humeral component fixation that avoid this critical stress riser and on the other hand we need to advise our patients about minimizing the risk of falling, especially when they have soft bone into which a stiff prosthesis has been inserted.

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