Saturday, February 1, 2014

CTA prosthesis in a skier - subsequent fracture.

Two years ago an active skier in his seventies presented with cuff tear arthropathy as shown in the x-ray below.
He had active elevation above 90 degrees and wanted to return to skiing so he chose a CTA arthroplasty instead of a reverse total shoulder to minimize the risk of serious fracture in the case of a fall.

This procedure was performed with impaction grafting to avoid the stress riser effects of a cemented prosthesis and that of a stem tightly fit in the diaphysis.

He returned to active skiing and subsequently returned to have the same procedure performed on his opposite side.

Again he returned to skiing with minimal complaints related to his shoulders.

He took a fall and sustained this fracture. Note that is is not a periprosthetic fracture - it took place below the tip of his prosthesis.

At 2.5 weeks his local doctors were concerned about lack of alignment as shown on this film and were considering operative treatment.
However, we pointed out that the above film was taken with the arm in external rotation, rather than in the sling position. We recommended keeping the arm in a sling and avoiding external rotation.

Five weeks after the fracture we were sent the films below showing good alignment and early healing.

We are anticipating that he'll be back on the slopes again next year.

Consultation for those who live a distance away from Seattle.

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