Intraoperative periprosthetic humeral fracture during reverse shoulder arthroplasty: a sequelae of prior biceps tenodesis

Abstract

Intraoperative periprosthetic humeral fractures are a rare but debilitating complication of reverse shoulder arthroplasty and can occur during multiple stages of the procedure. Prior biceps tenodesis has been found to reduce cortical humeral strength and predispose the patient to humeral fracture. We present a case of a 68-year-old female with a previous history of biceps tenodesis due to an irreparable rotator cuff tear. Months later, and after symptoms persisted, a reverse shoulder arthroplasty was performed. During the surgery and while performing final reduction, a fracture line was observed involving the hole used for the previous tenodesis procedure. The fracture was repaired, and the patient reported favorable outcomes. We report several factors that might have contributed to sustenance of this intraoperative fracture including prior biceps tenodesis, use of a press fit humeral stem, and the sex of the patient.

Keywords: Arthroplasty; Humeral fracture; Suture anchor; Tenodesis; Shoulder.

Fig. 1.

X-ray showing the biceps tenodesis hole (arrow) prior to reverse shoulder arthroplasty in the patient.

Fig. 2.

Intraoperative X-ray showing an oblique fracture of the humerus (arrow) in the patient.

Fig. 3.

X-ray of the shoulder at 5-month follow-up showing a stable implant in a good location with good bone healing.