Release notes for Periprosthetic shoulder fractures

The content was authored by Samy Bouaicha (CH), Stefaan Nijs (NE), Markus Scheibel (DE) and David Weatherby (US) with Simon Lambert (UK) as the editor.

The first edition of the periprosthetic shoulder module includes a detailed description of the following fracture types and their management.

Avulsion of the coracoid process:

• Nonoperative treatment
• ORIF - Lag screw fixation

Avulsion of the acromion:

• Nonoperative treatment
• ORIF - Lag screw fixation
• ORIF - Cerclage compression wiring
• ORIF - Reconstruction plate fixation

Spine of the scapula and spinoacromial fractures:

• Nonoperative treatment
• ORIF - Reconstruction plate fixation

Glenoid implant stable, good bone:

• Nonoperative treatment
• Revision of an anatomic metal-backed glenoid component
• Revision of a reverse glenoid baseplate

Glenoid implant loose, good bone:

• Nonoperative treatment
• Revision of an anatomic all polyethylene glenoid component
• Revision of an anatomic metal-backed glenoid component
• Revision of a hybrid glenoid component
• Revision of a reverse glenoid baseplate

Glenoid implant loose, poor bone, defect:

• Nonoperative treatment
• Revision of an anatomic all polyethylene glenoid component
• Revision of an anatomic metal-backed glenoid component
• Revision of a hybrid glenoid component
• Revision of a reverse glenoid baseplate
• Bony reconstruction with augmentation

Body of the scapula:

• Nonoperative treatment
• ORIF – plate fixation

Avulsion of the greater tuberosity:

• Nonoperative treatment
• ORIF - Plate fixation
• ORIF - Suture or screw fixation

Avulsion of the lesser tuberosity:

• Nonoperative treatment
• ORIF - Plate fixation
• ORIF - Suture or screw fixation

Humeral implant stable, good bone:

• Nonoperative treatment
• ORIF - Bridge plate fixation

Humeral implant loose, good bone:

• Nonoperative treatment
• ORIF - Bridge plate fixation
• Revision of a stemless implant
• Revision of a short stem
• Revision of a standard stem
• Humeral revision with allograft

Humeral implant loose, poor bone, defect:

• Nonoperative treatment
• ORIF - Bridge plate fixation
• Revision of a stemless implant
• Revision of a short stem
• Revision of a standard stem
• Bony reconstruction with augmentation

Fracture distal to the implant:

• Nonoperative treatment
• ORIF - Lag screw with plate fixation

The following additional material is available for this module.

Approaches:

• Deltopectoral approach
• Deltoid split approach
• Humeral osteotomy
• Posterior humeral approach
• Superior acromial anterior to posterior approach (Sabercut approach)
• Superior scapular approach
• Extended superior scapular approach
• Posterior approach to the scapular body

Patient preparations:

• Beach chair position at 30º
• Lateral decubitus position

Basic techniques:

• Basic technique – cemented stem
• Basic technique – hybrid stem
• Basic technique – uncemented stem
• Bony reconstruction with augmentation in the glenoid
• Bony reconstruction with augmentation in the proximal humerus
• Salvage techniques

Further reading:

• Imaging
• Infections
• Management of perioperative care
• One-stage or multiple-stage revision
• Patient preoperative evaluation
• Peri-implant fixation options
• Postoperative outcome assessment
• Preoperative functional assessment
• Shoulder implant configurations