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December 03, 2020
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Nonoperative treatment of periprosthetic humeral shaft fractures may achieve union

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Published results showed nonoperative treatment of periprosthetic humeral shaft fractures after reverse total shoulder arthroplasty may achieve fracture union.

Perspective from Tim Lenters, MD

Of 152 patients who underwent reverse TSA, Uma Srikumaran, MD, MBA, MPH, and colleagues identified five patients who experienced postoperative periprosthetic humeral shaft fracture, including two type A fractures, one type B fracture and two type C fractures. Researchers treated the five patients with a splint followed by a fracture brace or sling worn for 6 to 8 weeks and analyzed time to fracture union, single assessment numeric evaluation (SANE) scores, VAS score for pain and active shoulder range of motion.

Results showed four patients achieved fracture union with nonoperative treatment at a mean of 4.4 months. The mean SANE score was 55 and the mean VAS score was 3.4. The mean forward elevation was 83°, mean abduction was 65° and mean external rotation with the arm at the side was 15°, according to results. Researchers found complications included radial nerve palsy, acromial stress fracture, second periprosthetic fracture after a subsequent fall and hypertrophic nonunion treated with surgery.

Uma Srikumaran
Uma Srikumaran

“Not all periprosthetic fractures around a reverse TSA need surgical treatment,” Srikumaran told Healio Orthopedics. “This small case series suggests many of these periprosthetic fractures around a reverse TSA may benefit from a trial of nonoperative treatment, particularly for type A fractures with a well-fixed humeral component, well-aligned type B fractures and type C fractures.”