Periprosthetic humeral fractures after reverse shoulder arthroplasty. Case report

ABSTRACT Periprosthetic fractures is a severe complication after joint replacement. The rapidly increase of reverse shoulder arthroplasty surgeries, periprosthetic humeral fractures, which are described as rare, may increase in the near future. We report the case of displaced humeral fracture bellow the stem of reverse shoulder prosthesis. The patient was an 85-year-old woman who had a total shoulder replacement 6 years previously. The surgical solution consisted of plate osteossynthesis and cerclage. This report describes an unprecedented case in Brazilian literature; and gives an overview of the existing literature including this injury classification.

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Reverse Shoulder Arthroplasty for the Treatment of 3 and 4- Part Fractures of the Humeral Head in the Elderly

The Open Orthopaedics Journal ◽

10.2174/1874325001711010108 ◽

2017 ◽

Vol 11 (1) ◽

pp. 108-118 ◽

Cited By ~ 9

Author(s):

Ioannis Gigis ◽

Alexandros Nenopoulos ◽

Dimitrios Giannekas ◽

Roderich Heikenfeld ◽

Theodoros Beslikas ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Reverse Shoulder Arthroplasty ◽

Humeral Fracture ◽

The Elderly ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Long Term Results ◽

Cochrane Library ◽

Osteoporotic Bone ◽

Reverse Prosthesis

Background:Proximal humeral fractures in elderly patients present with severe comminution and osteoporotic bone quality.Reverse shoulder arthroplasty has lately been proven beneficial in treating patients with complex proximal humeral fractures. The above technique is recommended and has better results in elderly than in younger individuals.Methods:We performed a literature search in the databases Pubmed, Medline, EMBASE and Cochrane Library for published articles between 1970 and 2016 using the terms: proximal humerus fractures and reverse shoulder arthroplasty.Results:Significant benefits with the use of reverse prosthesis, especially in patients older than 70 years with a proximal humeral fracture, include reduced rehabilitation time as well as conservation of a fixed fulcrum for deltoid action in case of rotator cuff failure.Compared with hemiarthroplasty and internal fixation, reverse prosthesis may be particularly useful and give superior outcomes in older patients, due to comminuted fractures in osteopenic bones.However, significant disadvantages of this technique are potential complications and a demanding learning curve.Therefore, trained surgeons should follow specific indications when applying the particular treatment of proximal humeral fractures and be familiar with the surgical technique.Conclusion:Although long-term results and randomized studies for reverse prosthesis are lacking, short and mid- term outcomes have given promising results encouraging more shoulder surgeons to use this type of prosthesis in proximal humeral fractures.

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Cemented vs Uncemented Reverse Shoulder Arthroplasty for Acute Proximal Humeral Fractures

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2021.06.022 ◽

2021 ◽

Author(s):

Luciano A. Rossi ◽

Bruchmann Maria Guillermina ◽

Martin Buljubasich ◽

Nicolás Atala ◽

Ignacio Tanoira ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Reverse Shoulder Arthroplasty ◽

Proximal Humeral Fractures ◽

Humeral Fractures

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Reverse shoulder arthroplasty for proximal humeral fracture in the elderly. Cemented or uncemented stem?

International Orthopaedics ◽

10.1007/s00264-021-05284-y ◽

2022 ◽

Author(s):

Yaiza Lopiz ◽

Carlos García-Fernandez ◽

María Vallejo-Carrasco ◽

Daniel Garriguez-Pérez ◽

Loreto Achaerandio ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Proximal Humeral Fracture ◽

Reverse Shoulder Arthroplasty ◽

Humeral Fracture ◽

The Elderly

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Humeral Head Replacement and Reverse Shoulder Arthroplasty for the Treatment of Proximal Humerus Fracturesm

The Open Orthopaedics Journal ◽

10.2174/1874325001711011108 ◽

2017 ◽

Vol 11 (1) ◽

pp. 1108-1114 ◽

Cited By ~ 5

Author(s):

Aaron Andrew Frombach ◽

Kendra Brett ◽

Peter Lapner

Keyword(s):

Shoulder Arthroplasty ◽

New Technology ◽

Reverse Shoulder Arthroplasty ◽

Standard Of Care ◽

The Elderly ◽

Proximal Humeral Fractures ◽

Humeral Fractures ◽

Current Evidence ◽

Complication Rates ◽

Surgical Fixation

Acute proximal humeral fractures in the elderly are generally treated non-operatively if alignment is acceptable and in stable fracture patterns. When operative treatment is indicated, surgical fixation is often difficult or impossible to obtain. Hemiarthroplasty has long been the standard of care. However, with its reliance on tuberosity healing, functional outcomes and patient satisfaction are often poor. Reverse shoulder arthroplasty has emerged as a new technology for treating proximal humeral fractures but the indications for its use remain uncertain. While not conclusive, the evidence suggests that reverse shoulder arthroplasty yields more consistent results, with improved forward elevation and higher functional outcome scores. The primary advantages of hemiarthroplasty are improved shoulder rotation and shorter operative time. Complication rates do not vary significantly between the two options. Although higher quality trials are needed to further define the role of reverse shoulder arthroplasty, current evidence suggests that this is a reasonable option for surgeons who are highly familiar with its use.

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