Periprosthetic Humeral Fractures During Shoulder Arthroplasty

Kumar, Sanjay; Sperling, John W.; Haidukewych, George H.; Cofield, Robert H.

doi:10.2106/jbjs.h.00439

Cited by 206 publications

(116 citation statements)

References 28 publications

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“…To avoid potentially severe complications, the anterior circumflex vessels were ligated in four cases since then. Intraoperative periprosthetic fractures are rare: Athwal et al reported an incidence of 1.5% in a combined series of primary total shoulder arthroplasty, hemiarthroplasty, and revision total shoulder arthroplasty, 42% of them involving solely the greater tuberosity [1]. The fractured greater tuberosity in our series can be explained by the fact that the C-block osteotomy weakens the proximal humerus by interrupting the subcapital cortical ring, and by the osteopenic condition of this specific patient with sickle cell anemia.…”

Section: Discussionmentioning

confidence: 52%

“…The fractured greater tuberosity in our series can be explained by the fact that the C-block osteotomy weakens the proximal humerus by interrupting the subcapital cortical ring, and by the osteopenic condition of this specific patient with sickle cell anemia. Although these fractures are associated with a high rate of healing [1], as in our patient, it is advisable to handle the proximal humerus with extreme care to prevent this complication.…”

Section: Discussionmentioning

confidence: 71%

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Subscapularis Release in Shoulder Replacement Determines Structural Muscular Changes

Wilde

Coninck

Neve

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Osteotomy of the lesser tuberosity in shoulder arthroplasty allows bony healing of the subscapularis tendon but does not prevent fatty degeneration in its muscle. Occurrence or increase in fatty degeneration may depend on the surgical technique. Questions/purposes We (1) assessed fatty degeneration in the subscapularis muscle and its cross-sectional area after a C-block osteotomy of the lesser tuberosity with minimal mobilization of the subscapularis muscle, and (2) determined whether this technique had any adverse effect on function, fatty degeneration, and cross-sectional area of the subscapularis muscle. Methods We retrospectively examined 36 patients with shoulder replacements who had C-block osteotomies. Constant-Murley scores and clinical signs of subscapularis insufficiency were recorded. We radiographically assessed prosthetic placement. On CT scans, lesser tuberosity healing, fatty degeneration, and cross-sectional area of the subscapularis muscle were determined. The minimum followup was 13 months (mean, 18 months; range, 13-33 months).

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 71%

Subscapularis Release in Shoulder Replacement Determines Structural Muscular Changes

Wilde

Coninck

Neve

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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“…Periprosthetic fractures associated with anatomic shoulder arthroplasty are relatively uncommon, with an incidence between 0.6% and 3% [1,6,8,9,12,15,18,19,[24][25][26].…”

Section: Introductionmentioning

confidence: 99%

“…Although not studied as comprehensively as postoperative fractures, the incidence, risk factors, and outcomes associated with intraoperative periprosthetic fractures during anatomic shoulder arthroplasty has been characterized [1,19]. The rate of intraoperative fractures during revision primary anatomic arthroplasty is as much as 3.3% [1].…”

Section: Introductionmentioning

confidence: 99%

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What Are Risk Factors for Intraoperative Humerus Fractures During Revision Reverse Shoulder Arthroplasty and Do They Influence Outcomes?

Wagner

Houdek

Elhassan

et al. 2015

Clin Orthop Relat Res

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Background With the increase in shoulder arthroplasty rates, the number of perioperative complications, such as periprosthetic fractures, continues to be a rise; however, the risk factors and incidence of intraoperative complications, such as fractures, during revision reverse shoulder arthroplasty are not well established. Questions/purposes We evaluated patients receiving a reverse shoulder arthroplasty to determine (1) the frequency and characteristics of intraoperative humerus fractures, (2) the risk factors for fracture, (3) the complications associated with treatment of fractures, and (4) clinical and functional outcomes after treatment. Methods Using one institution's total joint registry, we performed a retrospective analysis of medical records of 224 patients (230 shoulders) who underwent revision surgery to reverse shoulder arthroplasty, from 2005 to 2012, for failed total shoulder arthroplasty. Reverse shoulder arthroplasty was used when there was a deficient rotator cuff, prior instability, or deficient glenoid bone stock. Intraoperative periprosthetic humerus fractures occurred in 36 shoulders (16%) (36 patients). The clinical outcome analysis included 29 patients with a minimum 2-year clinical followup (mean followup, 3.1 years; range, 2.0À6.3 years). The control group consisted of 188 patients (194 shoulders), and it was used for risk-factor calculation; whereas only 150 patients (154 shoulders) in the control group had a minimum 2-year followup, and thus only 150 patients (154 shoulders) made up the comparators (controls) for outcome-analysis comparisons. Risk factors were assessed using univariate analysis with odds ratios (OR), whereas implant survival and complications were assessed using the Kaplan-Meier method. Results Three displaced and 33 nondisplaced fractures occurred during revision reverse total shoulder arthroplasties. Most of the fractures (81%) occurred during component removal of cemented (n = 11) and cementless (n = 25) components. Intraoperative fractures only were treated with stabilization of the prosthetic stem in 28 patients, while adjunctive internal fixation was used in eight patients. Risk of intraoperative periprosthetic fractures was increased by factors including female sex (n =18 women; OR, 2.41; range, 1.11À5.68; p = 0.03); history of instability (n = 27; OR, 2.65; range, 1.18À5.93; p = 0.02); and prior hemiarthroplasty (n = 22; OR, 2.34; range, 1.13À4.84; p = 0.03). There were two postoperative fractures in patients who had an intraoperative fracture and both were treated nonoperatively. Overall, three (8%) revision procedures were performed in patients with intraoperative fractures, with 2-and 5-year survivorship estimates of 94% and 85%, respectively, compared with 89% and 84%, respectively for patients without an intraoperative fracture (p = 0.45). At latest followup, patients

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Radiographic morphometry and densitometry predict strength of cadaveric proximal humeri more reliably than age and DXA scan density

Skedros

Knight

Pitts

et al. 2015

Journal Orthopaedic Research

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Methods are needed for identifying poorer quality cadaver proximal humeri to ensure that they are not disproportionately segregated into experimental groups for fracture studies. We hypothesized that measurements made from radiographs of cadaveric proximal humeri are stronger predictors of fracture strength than chronological age or bone density values derived from dual-energy x-ray absorptiometry (DXA) scans. Thirty-three proximal humeri (range: 39-78 years) were analyzed for: (1) bone mineral density (BMD, g/cm 2 ) using DXA, (2) bulk density (g/cm 3 ) using DXA and volume displacement, (3) regional bone density in millimeters of aluminum (mmAl) using radiographs, and (4) regional mean (medialþlateral) cortical thickness and cortical index (CI) using radiographs. The bones were then fractured simulating a fall. Strongest correlations with ultimate fracture load (UFL) were: mean cortical thickness at two diaphyseal locations (r ¼ 0.71; p < 0.001), and mean mmAl in the humeral head (r ¼ 0.70; p < 0.001). Weaker correlations were found between UFL and DXA-BMD (r ¼ 0.60), bulk density (r ¼ 0.43), CI (r ¼ 0.61), and age (r ¼ À0.65) (p values <0.01). Analyses between UFL and the product of any two characteristics showed six combinations with r-values >0.80, but none included DXA-derived density, CI, or age. Radiographic morphometric and densitometric measurements from radiographs are therefore stronger predictors of UFL than age, CI, or DXA-derived density measurements. ß

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Periprosthetic Humeral Fractures During Shoulder Arthroplasty

Cited by 206 publications

References 28 publications

Subscapularis Release in Shoulder Replacement Determines Structural Muscular Changes

Subscapularis Release in Shoulder Replacement Determines Structural Muscular Changes

What Are Risk Factors for Intraoperative Humerus Fractures During Revision Reverse Shoulder Arthroplasty and Do They Influence Outcomes?

Radiographic morphometry and densitometry predict strength of cadaveric proximal humeri more reliably than age and DXA scan density

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