What is a Periprosthetic Shoulder Fracture?
A periprosthetic shoulder fracture is a fracture that occurs in the bone adjacent to a shoulder prosthesis.
Risk Factors for a Periprosthetic Shoulder Fracture
The risks factors for a periprosthetic shoulder fracture are:
- Reduced bone mineral density (osteoporosis or osteopenia)
- Female sex
- Advanced age
- Rheumatoid arthritis
Classification of Periprosthetic Shoulder Fractures
Periprosthetic fractures can be classified based on the location of the fracture in relation to the implant stem tip within the arm bone (humerus).
- Type A: Fracture is present near the stem tip, extending towards the shoulder
- Type B: Fracture is present near the stem tip, extending towards the elbow
- Type C: Fracture is present away from the stem tip towards the elbow
Diagnosis of Periprosthetic Shoulder Fractures
Your doctor will perform a careful physical exam to ensure blood vessels and nerves passing near the fracture site have not been injured. Imaging studies such as X-rays and CT scans may also be ordered to evaluate implant stability, bone quality, and soft tissues.
Fixation of Periprosthetic Shoulder Fractures
Nonoperative treatment with a fracture brace may be an option if:
- The fracture is located below the implant stem tip
- There is acceptable fracture alignment
- The prosthesis is well fixed
When the fracture line crosses the tip of the prosthesis and extends towards the elbow, open reduction and internal fixation (ORIF) of the fracture may be required. This can be achieved with the surgical placement of plates and screws or surgical wires to stabilize the fracture. Replacement with a long-stemmed implant that extends beyond the fracture line may also be required.
Revision surgery to replace the implant should be considered when the fracture line encompasses most of the shoulder prosthesis or if there is a loosening of the prosthesis.
Prognosis of Periprosthetic Shoulder Fracture Fixation
Overall, the prognosis is good as many cases can be treated nonoperatively. However, fixation of periprosthetic shoulder fractures can be very complicated, and each case is treated individually, depending on the severity of the fracture and the condition of the prosthesis.
Why Choose Dr. Acevedo for Periprosthetic Shoulder Fractures
Periprosthetic shoulder fractures are complex injuries that occur around a shoulder replacement and often require highly specialized evaluation and treatment. Patients choose Daniel C. Acevedo for his focused expertise in both shoulder arthroplasty and complex fracture care.
Reasons to choose Dr. Acevedo include:
- Fellowship-trained specialist in shoulder and elbow surgery
- Extensive experience managing fractures around shoulder implants
- Expertise in both non-surgical management and complex revision procedures
- Advanced surgical techniques, including fracture fixation and revision shoulder replacement
- Careful assessment of implant stability, bone quality, and fracture pattern before treatment
- Personalized treatment plans based on fracture severity and prosthesis condition
- Focus on restoring stability, alignment, and long-term shoulder function
- Experience with challenging cases involving loosening or implant failure
- Comprehensive care from diagnosis through post-surgical rehabilitation
- Commitment to patient education and clear, individualized treatment planning
Periprosthetic Shoulder Fracture FAQs
What causes a periprosthetic shoulder fracture?
These fractures are typically caused by trauma such as a fall, but they may also occur due to weakened bone, implant-related stress, or underlying conditions like osteoporosis. In some cases, they can occur during the original shoulder replacement surgery.
How is a periprosthetic shoulder fracture treated?
Treatment depends on the location of the fracture and whether the implant is stable.
- Stable implants may be treated with immobilization and close monitoring
- Unstable fractures or loose implants often require surgery, such as fixation with plates and screws or revision shoulder replacement
Do all periprosthetic shoulder fractures require surgery?
No, not all cases require surgery. If the implant is stable and the fracture is well-aligned, non-surgical treatment may be effective. Surgery is typically recommended when there is implant loosening, significant displacement, or poor bone support.
What are the risks or complications of a periprosthetic shoulder fracture?
Potential complications include delayed bone healing, implant loosening, shoulder stiffness, or decreased range of motion. In some cases, additional surgery may be needed if the fracture does not heal properly or if the implant becomes unstable. Early diagnosis and appropriate treatment can help reduce the risk of long-term complications and improve overall outcomes.
What is the recovery process like after a periprosthetic shoulder fracture?
Recovery often occurs in phases and may take several months. Early treatment focuses on protecting the shoulder with a sling, followed by gradual rehabilitation to restore motion and strength. Full recovery depends on fracture healing, implant stability, and adherence to physical therapy.
