Fracture distal to the implant
General considerations
The shoulder prosthesis may be stable and may not require revision.
Etiology
The humeral shaft fracture occurs as a result of:
- Twisting, eg, applying excessive torsional force during intraoperative location of a total shoulder replacement, or as a result of a standing height fall
- Bending, eg, as a result of a standing height fall
- Osteopenia
- Impaction, eg, excessive axial force during medullary preparation for humeral component implantation
- Distraction, eg, excessive axial force during explantation of a well-fixed humeral component in weak bone
Clinical signs
- Pain
- Swelling and bruising
- Restricted active movement
- Tenderness
- Associated nerve and vessel injuries
Imaging
Plain x-rays, including orthogonal AP and lateral views will show the fracture. CT may be indicated to assess the medullary dimension for revision implantation and fracture management.
