Intraoperative Fractures in Shoulder Arthroplasty: Risk Factors and Outcomes
These authors characterized the incidence of intra-operative fracture during shoulder arthroplasty and sought to identify risk factors for these fractures using an institutional database of shoulder arthroplasties (N = 1,773; 994 anatomic, 779 reverse).
They documented twenty-one (1.2%) intra-operative fractures (20 of the humerus one of the glenoid), the majority of which (91%) occurred in reverse shoulder arthroplasties compared to anatomic procedures (overall incidence:2.5% vs 0.2%). There were 7 intra-operative fractures of the greater tuberosity (33.3%), 8 metaphyseal fractures (38.1%), and 6 diaphyseal fractures (28.5%).
This study did not assess the effect of osteopenia on fracture risk.
Fractures occurred most commonly during either stem broaching (33%) or seating (33%), and were most likely to involve the metaphysis (53%) or greater tuberosity (33%). 5 fractures occurred during revision arthroplasty while 16 fractures occurred during primary procedures (overall incidence: 3.0 vs 1.0.
Risk factors included female gender, liver disease, and the use of short stems: 95% of the humeral fractures occurred with metaphyseal-fitting short stems while only 1 (5%) occurred with diaphyseal-fitting long stems.
Comment: This study calls attention to the risk of fracture with short humeral stems in reverse total shoulder arthroplasty. Impaction grafting of a standard stem may provide a safer approach, especially if bone quality is an issue; see this link.
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