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Non-operative management of humeral periprosthetic fracture after stemless shoulder arthroplasty

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Abstract

Purpose

Periprosthetic fractures around a stemless implant often involve lesser and greater tuberosities with a well-fixed implant in the metaphysis. This exposes the surgeon to unique questions and challenges as no surgical option (open reduction and internal fixation or revision to a stem) appears satisfactory to address them. Purpose of this study was to evaluate the clinical outcomes after non-operative management of periprosthetic fractures after stemless shoulder arthroplasty.

Methods

A retrospective multicenter study was conducted to identify all patients who had sustained non-operative management of a periprosthetic fracture after a stemless shoulder. Exclusion criteria were as follows: (1) intraoperative fractures and (2) implant loosening. Primary outcomes included mean Constant score and mean active range of motion. Secondary outcomes were VAS, radiological analysis, and complications.

Results

Nine patients were included. One was excluded due to the loss of follow-up at three months. Mean age was 79 years. At the last follow-up, no significant difference was observed between the Constant score, VAS, or the range of motion before fracture and at the last follow-up. Fracture healing did not result in any change in angulation in the frontal plane in seven cases and was responsible for a varus malunion in two cases of anatomic arthroplasty. No change in lateralization or distalization was reported. No cases of implant loosening after fracture have been observed.

Conclusions

Conservative management seems to be appropriate in cases of minimally displaced fractures without implant loosening.

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Authors and Affiliations

  1. APHP, Paris, France, 20 rue leblanc, 75015

    Ruben Dukan

  2. Institut Français de Chirurgie de la Main, Paris, France

    Marc Juvenspan

  3. Schulthess Klinik, Zurich, Switzerland

    Markus Scheibel & Philipp Moroder

  4. Clinique Saint Jean-Sud de France, Montpellier, France

    Philippe Teissier

  5. Hopital Ambroise Pare, Orthopedic Department, 9 Av. Charles de Gaulle, 92100, Boulogne-Billancourt, France

    Jean David Werthel

Authors
  1. Ruben Dukan
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  2. Marc Juvenspan
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  3. Markus Scheibel
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  4. Philipp Moroder
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  5. Philippe Teissier
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  6. Jean David Werthel
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Contributions

RD: writing and data collection.

MJ: data collection.

MS: data collection.

PM: data collection.

PT: data collection.

JDW: supervision.

Corresponding author

Correspondence to Ruben Dukan.

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Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Dukan, R., Juvenspan, M., Scheibel, M. et al. Non-operative management of humeral periprosthetic fracture after stemless shoulder arthroplasty. International Orthopaedics (SICOT) 48, 253–259 (2024). https://doi.org/10.1007/s00264-023-06005-3

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  • DOI: https://doi.org/10.1007/s00264-023-06005-3

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