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Humeral Shaft Fx-Periprosthetic

 

synonyms:

Periprosthetic Humeral Shaft Fracture ICD-9

Periprosthetic Humeral Shaft Fracture Etiology / Epidemiology / Natural History

  • Intraop caused by trauma or inproper technique (inadequate exposure, improper canal preparation, and prostheitic implant malpositioning)
  • Risk Factors: Osteoporosis, advanced age (general occurs in the 7th and 8th decades), femal sex, rheumotoid arthritis, soft-tissue contracture, prior malunion
  • Postoperative incidence = <1%, occurs at an average 49 months post-op (Kumar S, JBJS 2004;86A:680)

Periprosthetic Humerus Fx Avoidance

  • ensure patient is postioned so that the arm can easily be extended
  • perform complete capsular, subdeltoid, and subacromial releases
  • Use hand reamers with entry point approximately 1 cm posterior to the bicipital groove.
  • Only ream until cortical bone is contacted avoiding endosteal notching / stress risers

Periprosthetic Humeral Shaft Fracture Anatomy

Periprosthetic Humeral Shaft Fracture Clinical Evaluation

Periprosthetic Humeral Shaft Fracture Xray / Diagnositc Tests

Periprosthetic Humeral Shaft Fracture Classification / Treatment

  • Wright TW, JBJS 1995:77Am:1340
  • Intraoperative Displaced Tubersoity fracture: repair tuberosities with wire or heavy suture. Standard length stems indicated
  • Intraoperative Non-displaced fracture: no treatment necessary if componet is stable and stem bypasses the fracture by at least 2 cortical diameters
  • Intraoperatvie Displaced, or unstable stem: revise to a prosthesis which bypasses the fracture by 2 cortical diameters(long-stem prosthesis) +/- cerclage wiring, ORIF with plate and screws as indicated
  • Post-operative Non-displaced with stable componenets: non-operatvie treatment with coaptation splint, protected ROM/PT
  • Post-operative Displaced tuberosity fracture: ORIF with wires or heavy suture
  • Post-operative Long Oblique or spiral fracture with stable components: non-operative treatment with coaptation splint
  • Post-operative Unstable component: revision to long stem prosthesis, +/- cerclage wiring or plate and screws
  • Type-A: at the tip of the prosthesis and extend proximally
  • Type-B fractures: at the tip of the prosthesis without extension or with only minimal extension proximally but can have a variable amount of extension distally
  • Type-C fractures are located distal to the tip of the prosthesis.

Periprosthetic Humeral Shaft Fracture Associated Injuries / Differential Diagnosis

Periprosthetic Humeral Shaft Fracture Complications

  • nonunion
  • delayed union
  • radial nerve palsy
  • stiffness
  • skin breakdown

Periprosthetic Humeral Shaft Fracture Follow-up Care

Periprosthetic Humeral Shaft Fracture Review References

  • Cameraon B, Iannotti JP. Periprosthetic fractures of the humerus and scapula. Orthop Clin North Am. 1990:30:305-318
  • Wright TW, Cofield RH. Humeral fractures after shoulder arthroplasty. JBJS 1995:77Am:1340-1346
  • Campbell JT, Moore RS, Iannotti JP, Norris TR, Williams GR. Periprosthetic humeral fractures: mechanisms of fracture and treatment options. JSES. 1998;7:406-413
  • Worland RL, Kim Dy, Arredondo J. Periprosthetic humeral fractures: management and classification. JSES 1999;8:590-594
  • Boyd AD Jr, Thornhill TS, Barnes CL. Fractures adjacnet to humeral prosthesis. JBJS 1992;74A:1498-1504

 

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