Aim The gradual increase in shoulder implants in active elderly patients has appeared in a parallel increase in periprosthetic humeral fractures. The aim of this study was to investigate the advantages of using strut grafting with plate fixation during periprosthetic humerus fractures. Methods Thirty patients diagnosed with periprosthetic humeral fracture were divided into two groups. The first group of 15 patients (PS) underwent plate, ring, screws and strut allografts. The second group with resting 15 patients (PWS) was treated with only plate and screws. The criteria to evaluate the groups during followup were the Constant Shoulder Score (CSS) and Oxford Shoulder Score (OSS); the bone healing was measured by X-rays, controls measured by radiographic union score (RUS), and complications. The follow up was terminated at 12nd month in both groups. Results The difference between the two groups in all parameters was not significant. However, all patients gained adequate shoulder motor skills for normal daily living activities. All fractures were healed. Only two complications were registered, and blood loss was minimal. Conclusion We believe a revision to reverse shoulder prosthesis with a long-stem implant with or without cortical strut allograft augmentation to be safe and appropriate in the management of these complex injuries, though technically challenging, and having good results for normal activities daily life.
The effect of total shoulder arthroplasty on self-assessed health status is comparable to that of total hip arthroplasty and coronary artery bypass grafting. Vol. 12, J Shoulder Elbow Surg. 2003. p. 158–63.
2.
Trompeter AJ, Gupta RR. The management of complex periprosthetic humeral fractures: a case series of strut allograft augmentation, and a review of the literature. Vol. 8, Strat Traum Limb Recon. 2013. p. 43–51.
3.
Athwal GS, Sperling JW, Rispoli DM, Cofield RH. Periprosthetic humeral fractures during shoulder arthroplasty. Vol. 91, J Bone Joint Surg Am. 2009. p. 594–603.
4.
Sewell MD, Kang SN, Al-Hadithy N, Higgs DS, Bayley I, Falworth M, et al. Management of peri-prosthetic fracture of the humerus with severe bone loss and loosening of the humeral component after total shoulder replacement. Vol. 94, J Bone Joint Surg Br. 2012. p. 1382–9.
5.
Bohsali KI, Wirth MA, CA R. Complications of total shoulder arthroplasty. Vol. 88, J Bone Joint Surg Am. 2006. p. 2279–92.
6.
Bergdahl C, Ekholm C, Wennergren D, Nilsson F, Möller M. Epidemiology and patho-anatomical pattern of 2,011 humeral fractures: data from the Swedish Fracture Register. Vol. 17, BMC Musculoskelet Disord. 2016.
7.
Inoue K, Suenaga N, Oizumi N, Yamaguchi H, Miyoshi N, Taniguchi N, et al. Humeral bone resorption after anatomic shoulder arthroplasty using an uncemented stem. Vol. 26, J Shoulder Elbow Surg. 2017. p. 1984–9.
8.
Spormann C, Durchholz H, Audigé L, Flury M, Schwyzer HK, Simmen BR, et al. Patterns of proximal humeral bone resorption after total shoulder arthroplasty with an uncemented rectangular stem. Vol. 23, J Shoulder Elbow Surg. 2014. p. 1028–35.
9.
Carta S, Fortina M, Riva A, Meccariello L, Cataldi C, Colasanti GB, et al. Is there a rationale in the use of the bone strut allograft for management and internal fixation in periprosthetic humeral fractures? A case report. Vol. 12, EMBJ. 2017. p. 115–8.
10.
Kirchhoff C, Kirchhoff S, Biberthaler P. Periprosthetic humeral fractures: strategies and techniques for osteosynthesis. Vol. 119, Unfallchirurg. 2016. p. 273–80.
11.
Calori GM, Colombo M, Mazza EL, Mazzola S, Malagoli E, Marelli N, et al. Validation of the Non-Union Scoring System in 300 long bone nonunions. Vol. 45: (Suppl 6):S93-7, Injury. 2014.
12.
Ban I, Troelsen A, Christiansen DH, Svendsen SW, Kristensen MT. Standardised test protocol (Constant Score) for evaluation of functionality in patients with shoulder disorders. Vol. 60:A4608, Dan Med J. 2013.
13.
Dawson J, Rogers K, Fitzpatrick R, Carr A. The Oxford shoulder score revisited. Vol. 129, Arch Orthop Trauma Surg. 2009. p. 19–23.
14.
Determination of radiographic healing: an assessment of consistency using RUST and Modified RUST in metadiaphyseal fractures. Vol. 29, J Orthop Trauma. 2015. p. 516–20.
15.
Carta S, Fortina M, Riva A, Meccariello L, Manzi E, Giovanni A, et al. The biological metallic versus metallic solution in treating periprosthetic femoral fractures: outcome assessment. Vol. 2016, Adv Med. 2016.
16.
Raiss P, Edwards TB, Deutsch A, Shah A, Bruckner T, Loew M, et al. Radiographic changes around humeral components in shoulder arthroplasty. J Bone Joint Surg Am. 2014. p. 96 54.
17.
Oh JH, Song BW, Kim SH, Choi JA, Lee JW, Chung SW, et al. The measurement of bone mineral density of bilateral proximal humeri using DXA in patients with unilateral rotator cuff tear. Vol. 25, Osteoporos Int. 2014. p. 2639–48.
18.
Razfar N, Reeves JM, Langohr DG, Willing R, Athwal GS, Johnson JA. Comparison of proximal humeral bone stresses between stemless, short stem, and standard stem length: a finite element analysis. Vol. 25, J Shoulder Elbow Surg. 2016. p. 1076–83.
19.
Martinez AA, Calvo A, Cuenca J, Herrera A. Internal fixation and strut allograft augmentation for periprosthetic humeral fractures. Vol. 19, J Orthop Surg (Hong Kong. 2011. p. 191–3.
20.
Kumar S, Sperling JW, Haidukewych GH, Cofield RH. Periprosthetic humeral fractures after shoulder arthroplasty. J Bone Joint Surg Am. 2004.
21.
Wutzler S, Laurer HL, Huhnstock S, Geiger EV, Buehren V, Marzi I. Periprosthetic humeral fractures after shoulder arthroplasty: operative management and functional outcome. Vol. 129, Arch Orthop Trauma Surg. 2009. p. 237–43.
22.
Zhang BS, Li WY, Liu XH, Wei J, He L, Wang MY. Comparative results of non-operative and operative treatment of humeral shaft fractures. Vol. 49, Beijing Da Xue Xue Bao. 2017. p. 851–4.
23.
Rollo G, Tartaglia N, Falzarano G, Pichierri P, Stasi A, Medici A, et al. The challenge of non-union in subtrochanteric fractures with breakage of intramedullary nail: evaluation of outcomes in surgery revision with angled blade plate and allograft bone strut. Vol. 43, Eur J Trauma Emerg Surg. 2017. p. 853–61.
24.
Calori GM, Colombo M, Bucci MS, Fadigati P, Colombo AI, Mazzola S, et al. Complications in proximal humeral fractures. Vol. 47, Injury. 2016.
25.
Kurowicki J, Momoh E, Levy JC. Treatment of periprosthetic humerus fractures with open reduction and internal fixation. Vol. 30:e369-74, J Orthop Trauma. 2016.
26.
Casier S, Middernacht B, Tongel A, Wilde L. Revision of reversed shoulder arthroplasty: is a reoperation possible? Vol. 12, Obere Extrem. 2017. p. 16–24.
27.
Hernandez NM, Chalmers BP, Wagner ER, Sperling JW, Cofield RH, Sanchez-Sotelo J. Revision to reverse total shoulder arthroplasty restores stability for patients with unstable shoulder prostheses. Vol. 475, Clin Orthop Relat Res. 2017. p. 2716–22.
28.
Terragnoli F, Zattoni G, Damiani L, Cabrioli A, Li Bassi G. Treatment of proximal humeral fractures with reverse prostheses in elderly patients. Vol. 8, J Orthop Traumatol. 2007. p. 71–6.
29.
Rollo G, Rotini R, Pichierri P, Giaracuni M, Stasi A, Macchiarola L, et al. Grafting and fixation of proximal humeral aseptic nonunion: a prospective case series. Vol. 14, Clin Cases Miner Bone Metab. 2017. p. 298–304.
30.
Rollo G, Pichierri P, Marsilio A, Filipponi M, Bisaccia M, Meccariello L. The challenge of nonunion after osteosynthesis of the clavicle: is it a biomechanical or infection problem? Vol. 14, Clin Cases Miner Bone Metab. 2017. p. 372–8.
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.
