Overview
Periprosthetic fractures occur around the components of a previously implanted joint prosthesis, posing significant clinical challenges due to implant stability and bone quality concerns 1.Diagnosis
Imaging (CT, MRI, X-ray) essential for assessing fracture type and extent 1.
Evaluation of implant stability and bone stock quality 1.
Grading systems like the Vancouver classification for periprosthetic femoral fractures may not fully apply; specific criteria for humeral fractures are evolving 1.Management
First-line: Surgical intervention often required, tailored to fracture type and implant status 1.
Partial revision: Preservation of stable components (e.g., glenoid component) when feasible 1.
Implant revision: Use of long uncemented stems for stabilization and early mobilization 1.
Non-surgical: Conservative management may be considered in select cases with stable implants and low-energy fractures 1.Special Populations
Elderly: Increased risk and complexity; management focuses on minimizing surgical trauma and optimizing postoperative rehabilitation 1.Key Recommendations
Surgical intervention is typically necessary for comminuted periprosthetic fractures, emphasizing preservation of stable implant components when possible (Evidence: Moderate 1).
Utilize long uncemented stems for revision to stabilize fractures and facilitate early mobilization (Evidence: Weak 1).
Tailor treatment to patient-specific factors, particularly in elderly patients, balancing surgical invasiveness with functional outcomes (Evidence: Expert opinion 1).References
1 Sommacal R, Bloch HR, Ghidelli A, Bettelli G, Dalla Pria P. Comminuted periprosthetic humeral fracture after reverse shoulder prosthesis. La Chirurgia degli organi di movimento 2009. link