Salvage Reverse Shoulder Arthroplasty for Failed Proximal Humeral Fracture Fixation with Broken Implant

Proximal humerus fractures are very common injuries. In young people the treatment options include non-operative management, internal fixation, and in selected cases, shoulder arthroplasty. One of the most challenging complications after internal fixation is the fracture non-union that can lead to the dreaded implant breakage. In such a situation, the treatment depends on the patient's age, bone quality, bone loss, infection status, and functional demands, and consists of revision open reduction and internal fixation employing autologous bone grafting or conversion to shoulder arthroplasty. We report the case of a 38-year-old women who presented with painful shoulder stiffness, non-union and implant breakage three years following the internal fixation of an extra-articular humerus proximal fracture. The patient was successfully undergoing removal of the internal fixation and implantation of a cementless long-stem reverse shoulder arthroplasty. At four-year follow-up, the patient showed excellent functional recovery and stable implants on plain radiographs. This case underscores the significant therapeutic challenges in the case of non-union and implant breakage after failure of an internal fixation for a displaced extra-articular humerus fracture in young people and highlights the role of reverse shoulder arthroplasty conversion as an effective salvage solution, providing pain relief, functional recovery and radiographic stability. Proper pre-operative planning, implant selection, and a meticulous intra-operative technique remain key factors for achieving favourable results in similar complex conditions.