Periprosthetic humeral fractures: Strategies and techniques of revision arthroplasty

• Published in: Der Unfallchirurg Vol. 119; no. 4; pp. 281 - 287
• Main Authors: Kirchhoff, C, Beirer, M, Brunner, U
• Format: Journal Article
• Language: German
• Published: Germany 01.04.2016
• Subjects: Arthroplasty, Replacement, Shoulder - instrumentation; Arthroplasty, Replacement, Shoulder - methods; Evidence-Based Medicine; Fracture Fixation, Internal - instrumentation; Fracture Fixation, Internal - methods; Humans; Periprosthetic Fractures - diagnosis; Periprosthetic Fractures - surgery; Preoperative Care - methods; Reoperation - instrumentation; Reoperation - methods; Shoulder Fractures - diagnostic imaging; Shoulder Fractures - surgery; Shoulder Prosthesis; Treatment Outcome; Osteoporosis; Complication; Long stem prosthesis; Risk factors; Classification
• ISSN: 1433-044X
• DOI: 10.1007/s00113-016-0158-4

The primary aims when performing revision arthroplasty of periprosthetic humeral fractures (PHF) are preservation of bone stock, achieving fracture healing and preserving a stable prosthesis with the focus on regaining the preoperative shoulder-arm function. The indications for revision arthroplasty are given in PHF in combination with loosening of the stem. In addition, further factors must be independently clarified in the case of an anatomical arthroplasty. In this context secondary glenoid erosion as well as rotator cuff insufficiency are potential factors for an extended revision procedure. For the performance of revision surgery modular revision sets including long stems, revision glenoid and metaglene components as well as plate and cerclage systems are obligatory besides the explantation instrumentation. Despite a loosened prosthesis, a transhumeral removal of the stem along with a subpectoral fenestration are often required. Length as well as bracing of revision stems need to bridge the fracture by at least twice the humeral diameter. Moreover, in many cases a combined procedure using an additional distal open reduction and internal fixation (ORIF) plus cable cerclages as well as biological augmentation might be needed. Assuming an adequate preparation, the experienced surgeon is able to achieve a high fracture union rate along with an acceptable or even good shoulder function and to avoid further complications.