[Prosthesis replacement in periprosthetic humeral fractures]

Abstract

Objective: Stabilization of the humerus with preservation or restoration of the shoulder function.

Indications: Always in the presence of a loose prosthesis. It may become necessary in conditions of poor bone stock and if osteosynthesis is not possible.

Contraindications: Noncompliant patients due to alcohol or drugs. Local infections.

Surgical technique: The loose implant is removed using an extended anterior deltopectoral approach. After exploration of the fracture and extended soft tissue release, the glenoidal components are implanted with visualization and protection of the axillary nerve. A long stemmed implant is typically needed on the humeral side. It is anchored in the distal fragment over a length of about 6 cm. Soft tissue tension is crucial, especially with reverse shoulder arthroplasty.

Postoperative management: Postoperatively, the affected limb is immobilized for 6 weeks on a 15° shoulder abduction pillow with active assisted movement therapy up to the horizontal plane. This is followed by gradual pain-adapted increases of movement, muscle coordination, and strength.

Results: In 17 patients with periprosthetic fractures of the humerus surgically treated in our institution, 4 underwent revision arthroplasty because of a loose prosthesis. No intra- or postoperative complications were observed. All fractures healed except one.

Keywords: Humerus fracture; Periprosthetic fracture; Shoulder; Shoulder replacement; Surgical revision.