Conservative treatment of periprosthetic proximal humerus fractures after stemless total shoulder arthroplasty: a case series
Article
Skerry, TP, Moutafis, AD, Santos, ED et al. (2026). Conservative treatment of periprosthetic proximal humerus fractures after stemless total shoulder arthroplasty: a case series
. 36(2), 10.1016/j.sart.2026.151571
Skerry, TP, Moutafis, AD, Santos, ED et al. (2026). Conservative treatment of periprosthetic proximal humerus fractures after stemless total shoulder arthroplasty: a case series
. 36(2), 10.1016/j.sart.2026.151571
Background: This study aimed to assess patient-reported outcomes (PROs) of conservatively treated periprosthetic proximal humerus fractures (PPHFs) after stemless inlay total shoulder arthroplasty (iTSA). We hypothesize that patients with PPHF will achieve comparable PROs and range of motion (ROM) to matched controls. Methods: Conservatively treated PPHFs were reviewed from our prospectively collected iTSA database (2011-2024). PPHFs that underwent immediate surgical intervention were excluded. Fracture categorization (Neer classification), humoral shaft angle, and union were evaluated radiographically. PROs included American Shoulder and Elbow Surgeons (ASES), Western Ontario Osteoarthritis of the Shoulder Percentage (WOOS%), Single Assessment Numeric Evaluation (SANE), visual analog scale for Pain (VAS-Pain), and satisfaction. Patients with fractures (group 1) were matched with 12 nonfracture patients (group 2) using 7 covariates (propensity match). Comparative analyses employed two-sample t-tests or Wilcoxon rank-sum tests (Rstudio). Eight periprosthetic humeral fractures were identified (1.4%). Six periprosthetic proximal humeral fractures were included in the study. Results: Eight periprosthetic humeral fractures were identified out of 584 patients with iTSAs (incidence: 1.4%). Six conservatively treated patients (4 males, 2 females) were included in the case series. PPHFs occurred at a mean of 36.0±25.5 months after iTSA. Neer classifications included type 1 (n=5) and type 2 (n=1). The mean follow-up was 60.0±33.9 months from iTSA and 34.0±25.7 months postfracture. Bony union occurred in 100% of patients at an average of 81.3±35.1 days. The humoral shaft angle decreased in 5 shoulders preinjury to postfracture (range: 16.0-19.6°). There were no statistically significant differences between group 1 and 2 ROM (forward flexion P = .150, external rotation P = .531) or PROs (ASES P = .904, WOOS% P = .604, SANE P = .821, VAS-Pain P = .158, satisfaction P = .254). Group 1 PROs returned to prefracture levels in satisfaction, WOOS% (P = .285), ASES (P = 1.000), VAS-Pain (P = .180), and SANE (P = .317). External rotation (P = .180) and forward flexion (P = .916) remained unchanged at final follow-up. No complications occurred. Conclusion: Conservatively managed PPHFs achieved 100% union and similar outcomes to matched controls, with restored or improved PROs and ROM.
