Introduction

As the reverse total shoulder arthroplasty (RTSA) surgery has dramatically increased in the last few decades, many complications have followed through. The periprosthetic fracture, at the moment, is still a subject of debate in the orthopedic world. In this monocentric study, along with a literature review of periprosthetic humeral fractures, we would present our institutional experience with the treatment of periprosthetic humeral fractures with a posterior humeral approach, posterior cortex plate fixation, anterior strut allograft, screws, and cerclage wires.

Materials and Methods

Our study consisted in a prospective monocentric study based on 18 patients, with a mean age of 75.3 years (range 64–88), all following a reverse shoulder total arthroplasty (RTSA). Postoperative follow-ups were taken at 1, 6, and 12 months with objective measurement of shoulder motion and strength, while clinical outcome measures were assessed using the American Shoulder and Elbow Surgeons (ASES score) and visual analog scale (VAS) for pain. Together with that, we performed a literature review focused on the management of periprosthetic humeral fractures after shoulder arthroplasty.

Results

All fractures consolidated without complication at a mean 4.2 months (range 3–6). At final follow-up, the average active shoulder flexion was 88° (range 62–129°), active abduction 73° (range 52–91°) and active external rotation 22° (range 3–56°). The average ASES score was 73 (range 59–97), while average VAS score was 1.1 (range 0–3).

Discussion

Surgical treatment of periprosthetic humeral fractures following a shoulder arthroplasty remains a hard challenge for every surgeon, and their treatment must consider fracture’s location, displacement, and local bone quality.

Conclusions

The posterior approach with a posterior plate placement and anterior strut allograft, which is appliable only in case of a B or C type fracture according to Worland classification, could be a good treatment option for periprosthetic humeral fractures.

中文翻译：

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后路锁定加压钢板和前路同种异体移植物的后路入路在反向全肩关节置换术后假体周围肱骨骨折的治疗中是否有用且安全？

介绍

随着反向全肩关节置换术 (RTSA) 手术在过去几十年中急剧增加，许多并发症也随之而来。目前，假体周围骨折仍然是骨科界争论的话题。在这项单中心研究中，连同对肱骨假体周围骨折的文献回顾，我们将介绍我们在使用肱骨后路入路、后皮质板固定、同种异体前支架、螺钉和环扎钢丝治疗肱骨假体周围骨折的机构经验。

材料和方法

我们的研究包括一项基于 18 名患者的前瞻性单中心研究，平均年龄为 75.3 岁（范围 64-88 岁），均在反向肩全关节置换术 (RTSA) 后进行。术后 1、6 和 12 个月进行随访，客观测量肩部运动和力量，同时使用美国肩肘外科医生 (ASES) 和视觉模拟量表 (VAS) 评估临床结果测量值。与此同时，我们对肩关节置换术后肱骨假体周围骨折的处理进行了文献综述。

结果

所有骨折均在平均 4.2 个月（范围 3-6）内无并发症巩固。在最后的随访中，平均主动肩屈曲为 88°（范围 62-129°），主动外展 73°（范围 52-91°）和主动外旋 22°（范围 3-56°）。平均 ASES 得分为 73（范围 59-97），而平均 VAS 得分为 1.1（范围 0-3）。

讨论

肩关节置换术后肱骨假体周围骨折的手术治疗对于每位外科医生来说仍然是一项艰巨的挑战，他们的治疗必须考虑骨折的位置、移位和局部骨质量。

结论

根据 Worland 分类，仅适用于 B 或 C 型骨折的后路入路，带有后钢板放置和前支撑同种异体移植物，可能是肱骨假体周围骨折的良好治疗选择。