Humeral implant loose, poor bone, defect
General considerations
The humeral component is loose. The shoulder joint may be unstable. The principles of fracture treatment are similar to those used for metaphyseal and diaphyseal humeral fractures, but the humeral stem will require revision. The type of humeral revision will determine the type of fracture management. Bone graft or augmented fixation may be required. Augmented or custom prostheses may be required.
Etiology
The humeral shaft fracture occurs as a result of:
- Osteopenia
- Weakening of bone caused by infection
- Twisting with axial loading, eg, as a result of a standing height fall
- Bending, eg, as a result of a standing height fall
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. Nuclear radio isotope imaging may be useful for the diagnosis of infection.
