Management of Periprosthetic Proximal Humerus Fractures Following Shoulder Arthroplasty: A Systematic Review

Periprosthetic proximal humeral fractures following shoulder arthroplasty are rare but present significant clinical challenges due to variable fracture patterns, stem stability, and patient factors. This systematic review aimed to summarize contemporary evidence on management strategies, including nonoperative treatment, open reduction and internal fixation (ORIF), and revision arthroplasty, and to evaluate outcomes, complications, and factors influencing fracture healing. A comprehensive search of PubMed, Embase, Scopus, and the Cochrane Library identified eight studies meeting the inclusion criteria, encompassing 210 patients with fractures classified using the Cofield or Worland systems. ORIF was the most commonly reported intervention, achieving union rates of up to 93%, while nonoperative management was associated with higher nonunion and malunion rates. Revision arthroplasty provided moderate union rates (~84%) but carried higher complication risks. Successful outcomes were linked to humeral stem stability, fracture displacement, and individualized, fracture-specific management. Current evidence highlights the need for standardized classification systems, prospective multicenter studies, and evaluation of novel fixation techniques to improve union rates and functional recovery in this complex patient population.