Complex Periprosthetic Humerus Fracture with Failed Osteosynthesis in an Elderly Osteoporotic Woman Managed with...

Periprosthetic humeral fractures are rare but serious complications following shoulder arthroplasty, especially in elderly patients with osteoporosis. These fractures pose a significant management challenge due to compromised bone quality and the presence of prosthetic components. Salvage procedures such as vascularized fibular grafting offer a biologically and mechanically favorable option in complex cases with failed internal fixation.

We present the case of an 80-year-old female with systemic hypertension and osteoporosis, who sustained a periprosthetic fracture of the right humerus, which was categorized under the Wright and Cofield classification as Type B. She was initially treated with internal fixation of the fracture, and 3 weeks later, presented with implant failure following a trivial trauma. After initial stabilization and medical optimization, she underwent open reduction and internal fixation of the right humerus with vascularized fibular grafting harvested from the opposite leg. Medical management of osteoporosis was also initiated in the post-operative period. At 3 months follow-up, she had clinical and radiological healing of the fracture, restoration of full shoulder range of motion, and activities of daily living. This case highlights the complexity of managing periprosthetic humeral fractures in osteoporotic patients. Standard fixation techniques are often inadequate due to poor bone stock and fraught with high failure rates. Vascularized fibular grafting, though more commonly used in long bone non-unions, can provide durable fixation and enhance osteogenesis in selected cases.

Vascularized fibular grafting is an effective option in managing failed fixation of periprosthetic fractures in severely osteoporotic patients. A multidisciplinary approach and individualized surgical planning are crucial for optimal outcomes.