Periprosthetic Shoulder Fracture Fixation

Periprosthetic Shoulder Fracture Fixation

What is Periprosthetic Shoulder Fracture Fixation?

Periprosthetic shoulder fracture fixation is a surgical procedure used to stabilize and repair a fracture that occurs around a shoulder prosthesis (such as after a total shoulder replacement or reverse total shoulder replacement). These fractures may involve the humerus (upper arm bone) or, less commonly, the glenoid (shoulder socket). Because the presence of an implant complicates treatment, the fixation must be carefully planned to maintain implant stability while allowing bone healing.

When is Periprosthetic Shoulder Fracture Fixation Indicated?

Periprosthetic shoulder fracture fixation is indicated when a fracture occurs around a shoulder prosthesis (anatomic or reverse) and cannot be managed conservatively. The decision depends on fracture type, displacement, bone quality, and implant stability. Main indications include the following:

• Displaced fractures that cannot be maintained in alignment with non-operative care.
• Fractures around a well-fixed prosthesis (implant stable, bone–implant interface intact) where fixation can restore stability.
• Periprosthetic fractures with poor healing potential (osteoporotic bone, high risk of nonunion).
• Functional needs in active patients who require better shoulder mobility and strength.
• Fractures compromising implant stability or threatening loosening if left untreated.

What Does the Procedure for Periprosthetic Shoulder Fracture Fixation Involve?

During periprosthetic shoulder fracture fixation surgery, the surgeon’s goal is to stabilize the fracture, maintain or restore implant stability, and promote healing while preserving shoulder function. The exact steps depend on the fracture type and whether the prosthesis is stable. In general, the procedure involves the following steps:

• The patient is given general or regional anesthesia and positioned (often in a beach-chair position) for surgical access.
• The surgeon makes an incision to reach the fractured area around the prosthesis.
• The implant is carefully checked to see if it is firmly fixed or loose, since this determines the surgical approach.
• If the prosthesis is stable, the fracture is fixed using locking plates, screws, cerclage wires, or cables to secure the bone fragments.
• If the prosthesis is loose or the fracture cannot be stabilized, revision surgery may be performed with a longer-stem prosthesis or replacement components.
• The incision is closed with sutures, and a sterile dressing is applied.

What Happens After Periprosthetic Shoulder Fracture Fixation Surgery?

After periprosthetic shoulder fracture fixation surgery, the arm is usually placed in a sling for protection and comfort. Pain and swelling are managed with medications and ice therapy. In the first few weeks, movement is limited to allow the bone and fixation to heal, followed by gradual introduction of physical therapy to restore mobility and strength. Healing may take several months, and full recovery depends on factors like bone quality, fracture type, and implant stability. Regular follow-up visits and X-rays are done to monitor bone healing and prosthesis function.

What are the Risks and Complications of Periprosthetic Shoulder Fracture Fixation?

Risks and complications of periprosthetic shoulder fracture fixation may include the following:

• Infection
• Bleeding or hematoma
• Nerve or blood vessel injury
• Nonunion or delayed bone healing
• Loosening of the prosthesis
• Hardware failure (plates, screws, or cables)
• Shoulder stiffness or reduced range of motion
• Need for revision surgery