Treatment of periprosthetic humerus fractures associated with shoulder arthroplasty

The incidence of periprosthetic humerus fracture associated with shoulder arthroplasty is approximately 0.6% to 3%. Fractures of the humerus occur most often intraoperatively and are more common during total shoulder arthroplasty than hemiarthroplasty because of difficulties in gaining access to the glenoid. Osteopenia, advanced age, female sex, and rheumatoid arthritis are medical comorbid factors that may contribute to humerus fractures and associated delayed healing and poorer function. When the humeral prosthetic component is loose or the fracture line overlaps the majority of the length of the prosthesis, revision with a long-stem implant should be considered. When the fracture overlaps the tip of the prosthesis and extends distally, open reduction and internal fixation is recommended. When the fracture is completely distal to the prosthesis and satisfactory alignment at the fracture site can be maintained with a fracture brace, then a trial of nonsurgical treatment is recommended. The primary goals of treatment are fracture union and pain relief. Loss of glenohumeral motion has limited the successful treatment of this challenging problem.