Short Stem Reverse Total Shoulder Arthroplasty Periprosthetic Type A Fracture

Abstract

Alterations have been made over the years to the standard reverse total shoulder arthroplasty (RTSA) prosthetic components in an effort to decrease adverse events; this has led to the advent of a short humeral stem prosthesis. To the authors' knowledge, there are no reports describing the complication of a traumatic periprosthetic Wright and Cofield classification type A fracture with use of a short metaphyseal humeral stem component for RTSA. The authors describe a 49-year-old woman with this pathology who was treated with open reduction and internal fixation using a proximal humerus locking plate, unicortical and bicortical screw fixation, and a cerclage wire construct without the need to violate the shoulder joint or revise components. Three months postoperatively, she was instructed to begin active range of motion in physical therapy. At 13 months postoperatively, the patient rated her pain level at an average 5 of 10 in severity, with active assisted scaption to 125°, external rotation to 15°, and internal rotation to L5. Radiographs at this time revealed a well-healed fracture. This not only indicates the previously unreported occurrence of such a complication pattern, which was thought rare with the advent of the short humeral RTSA stem, but also provides a viable intraoperative strategy for open reduction and internal fixation with a proximal humerus locking plate, unicortical and bicortical screw fixation, and a cerclage wire construct without the need to violate the shoulder joint. [Orthopedics. 2017; 40(4):e721-e724.].