EVALUATION AND TREATMENT OF POSTOPERATIVE PERIPROSTHETIC HUMERAL FRAGILITY FRACTURES

Main Article Content

Muhammad Ibrahim Khan
Syed Muhammad Tayyab Hassan
Muhammad Imran Haider
Aman Ullah Khan Kakar
Syed Abdur Rub Abidi

Keywords

Abstract

Background: Postoperative periprosthetic humeral fragility fractures pose significant challenges in orthopedic practice, particularly as the aging population undergoes increasing shoulder arthroplasty procedures.


Objectives: This study, involving 210 patients, aimed to comprehensively evaluate and treat these fractures, considering diverse demographic factors, fracture characteristics, and varied treatment modalities.


Methods: A prospective design was employed, with meticulous data collection encompassing patient demographics, fracture patterns, implant details, and treatment outcomes. Statistical analyses, including comparative assessments, were conducted to elucidate the effectiveness of conservative and surgical interventions. Ethical considerations were paramount throughout the study.


Results: The study revealed a diverse cohort with an average age of 68, demonstrating prevalent comorbidities. Fracture patterns varied, emphasizing the importance of individualized treatment plans. Both conservative measures and surgical interventions demonstrated positive outcomes, with encouraging results at short-term follow-ups and minimal complications.


Practical Implications: Demographic considerations, fracture characteristics, and treatment outcomes were discussed, highlighting the adaptability of approaches based on individual patient profiles. Statistical analyses supported the efficacy of both conservative and surgical strategies, providing valuable insights for orthopedic practitioners.


Conclusion: In conclusion, this study underscores the importance of a tailored, patient-centered approach in managing postoperative periprosthetic humeral fragility fractures. The favorable outcomes observed at short-term follow-ups affirm the adaptability of treatment modalities, guiding orthopedic practice and laying the foundation for future research in this complex orthopedic scenario.

Abstract 161 | PDF Downloads 86

References

1. Kobayashi, Evangeline F., et al. "Evaluation and Treatment of Postoperative Periprosthetic Humeral Fragility Fractures." OTA International, vol. 6, no. 1 Suppl, 2023,
https://doi.org/10.1097/OI9.0000000000000244.
2. Cuff DJ, Pupello DR, Santoni BG, et al.. Reverse shoulder arthroplasty for the treatment of rotator cuff deficiency: a concise follow-up, at a minimum of 10 years, of previous reports. J Bone Joint Surg Am. 2017;99:1895–1899.
3. Boileau P. Complications and revision of reverse total shoulder arthroplasty. OrthopTraumatol Surg Res. 2016;102:S33–S43.
4. Oliver WM, Searle HKC, Ng ZH, et al.. Fractures of the proximal- and middle-thirds of the humeral shaft should be considered as fragility fractures: an epidemiological study of 900 consecutive injuries. Bone Joint J. 2020;102-B:1475–1483.
5. Novi M, Porcellini G, Donà A, et al.. A long-term follow-up of post-operative periprosthetic humeral fracture in shoulder arthroplasty. Geriatr Orthop Surg Rehabil. 2021;12:215145932110399.
6. Hecker A, Jungwirth-Weinberger A, Bauer MR, et al.. The accuracy of joint aspiration for the diagnosis of shoulder infections. J Shoulder Elbow Surg. 2020;29:516–520.
7. Kirchhoff C, Beirer M, Brunner U, et al.. Validation of a new classification for periprosthetic shoulder fractures. Int Orthop. 2018;42:1371–1377
8. Thés A, Klouche S, de Tienda M, et al.. Cortical onlay strut allograft with cerclage wiring of periprosthetic fractures of the humerus without stem loosening: technique and preliminary results. Eur J Orthop Surg Traumatol. 2017;27:553–557
9. Graham SM, Mak JH, Moazen M, et al.. Periprosthetic femoral fracture fixation: a biomechanical comparison between proximal locking screws and cables. J Orthop Sci. 2015;20:875–880.
10. Schoch B, Mehta S, Namdari S. Surgical fixation of periprosthetic humerus fractures using an extension plate: surgical technique and report of 5 cases. J Orthop Trauma. 2017;31:e432–e435
11. Vicenti G, Solarino G, Carrozzo M, et al.. Is the posterior approach with posterior locking compression plate and anterior allograft useful and safe in the treatment of periprosthetic humeral fractures following reverse total shoulder arthroplasty? GeriatrOrthop Surg Rehabil. 2022;13:215145932210809
12. Canton G, Fazzari F, Fattori R, et al.. Post-operative periprosthetic humeral fractures after reverse shoulder arthroplasty: a review of the literature. Acta Bio Medica Atenei Parm. 2019;90:8–13
13. Cox JL, McLendon PB, Christmas KN, et al.. Clinical outcomes following reverse shoulder arthroplasty–allograft composite for revision of failed arthroplasty associated with proximal humeral bone deficiency: 2- to 15-year follow-up. J Shoulder Elbow Surg. 2019;28:900–907
14. Sanchez-Sotelo J, Wagner ER, Houdek MT. Allograft-prosthetic composite reconstruction for massive proximal humeral bone loss in reverse shoulder arthroplasty. JBJS Essent Surg Tech. 2018;8:e3
15. Kobayashi EF, Namdari S, Schenker M, Athwal GS, Ahn J. Evaluation and treatment of postoperative periprosthetic humeral fragility fractures. OTA Int. 2023 Mar 28;6(1 Suppl):e244. doi: 10.1097/OI9.0000000000000244. PMID: 37006451; PMCID: PMC10064642.
16. Ross, A. J., Ross, B. J., Lee, O. C., Guild III, G. N., & Sherman, W. F. (2021). The impact of prior fragility fractures on complications after total hip arthroplasty: A propensity score–matched cohort study. Arthroplasty Today, 11, 41-48.
17. Testa, E. J., Albright, J. A., Lemme, N. J., Molla, V., McCrae, B., Daniels, A. H., & Paxton, E. S. (2022). Increased risk of periprosthetic fractures and revision arthroplasty in patients undergoing shoulder arthroplasty with a history of prior fragility fractures: a matched cohort analysis. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 10-5435.
18. Binkley, N., Nickel, B., & Anderson, P. A. (2023). Periprosthetic fractures: an unrecognized osteoporosis crisis. Osteoporosis International, 34(6), 1055-1064.
19. Agarwal, A. R., Cohen, J. S., Tarawneh, O. H., Gu, A., Debritz, J., Golladay, G. J., & Thakkar, S. C. (2023). The impact of prior fragility fractures on long-term periprosthetic fracture risk following total knee arthroplasty. Osteoporosis International, 1-8.

Most read articles by the same author(s)