Periprosthetic Fractures Around Shoulder Arthroplasty: Tips and Tricks for Management of Challenging Injuries

Periprosthetic fractures associated with shoulder arthroplasty are on the rise, which include humeral shaft fractures as well as scapular spine and acromion fractures. Although some of these fractures can be treated nonsurgically, surgery is indicated in certain situations. Because it is related to periprosthetic humeral shaft fractures, the Unified Classification System for Periprosthetic Fractures can be used to guide treatment. Type A fractures are stable and can be treated nonsurgically. Type B fractures at the tip of the stem have a high risk of failure with nonsurgical treatment, and benefit from surgical fixation. If the stem is stable (type B1), the fracture can be treated with open reduction and internal fixation. If the stem is unstable (type B2), revision arthroplasty is the treatment of choice. If there is bone loss associated with the loose stem (type B3), revision arthroplasty with allograft or megaprosthesis is the preferred method of treatment. For fractures well distal to the stem (type C) treatment is similar to that for native humeral fractures. Regarding acromial and scapular spine fractures, it is now recognized that patients who sustain this complication have poor outcomes with nonsurgical treatment, and surgical fixation is performed more frequently. Fixation techniques for acromial fractures are still evolving, and more literature in this field is needed.