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Scientific Articles   |    
Surgically Treated Humeral Shaft Fractures Following Shoulder Arthroplasty
Jaron R. Andersen, MD1; Christopher David Williams, BS2; Richard Cain, MD3; Mark Mighell, MD2; Mark Frankle, MD2
1 1808 Verdugo Boulevard, Suite 112, Glendale, CA 91208
2 Foundation for Orthopaedic Research and Education (C.D.W.), Florida Orthopaedic Institute (M.M. and M.F.), 13020 North Telecom Parkway, Tampa, FL 33637. E-mail address for M. Frankle: frankle@pol.net
3 USF College of Medicine, 12901 Bruce B. Downs Boulevard, MDC 2, Tampa, FL 33612
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  • Disclosure statement for author(s): PDF

Investigation performed at the Florida Orthopaedic Institute, Tampa, Florida

A commentary by Jonathan P. Braman, MD, and Alicia K. Harrison, MD, is linked to the online version of this article at jbjs.org.



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, one or more of the authors has had another relationship, or has engaged in another activity, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Jan 02;95(1):9-18. doi: 10.2106/JBJS.K.00863
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Abstract

Background: 

We reviewed a consecutive series of patients with a humeral fracture around either an anatomic or a reverse shoulder prosthesis treated with either open reduction and internal fixation (ORIF) or revision shoulder arthroplasty. The purposes of the study were to (1) describe the treatment of these fractures by either method, (2) report the outcomes, and (3) assess the validity of a current classification system.

Methods: 

Indications for surgery were a displaced unstable fracture, a fracture around a loose humeral stem, or a patient who was unable to tolerate conservative treatment. Outcomes were reported for two groups (patients treated with revision arthroplasty and those treated only with ORIF) and included American Shoulder and Elbow Surgeons (ASES) scores, radiographic evidence of fracture union, and complications.

Results: 

The mean ASES score for the entire cohort was 50.3 (95% confidence interval: 41.2 to 59.5). Thirty-five of the thirty-six fractures healed, in a mean of 7.2 months (range, 3.25 to 13.5 months). Complications occurred in fourteen (39%) of the thirty-six patients. Our ability to classify these fractures with a previously defined system had a low interobserver reliability (mean kappa, 0.37; range, 0.24 to 0.50) and a high intraobserver reliability (mean kappa, 0.69; range, 0.52 to 0.89).

Conclusions: 

Periprosthetic fracture around a humeral stem implant is a difficult clinical problem involving complex decision-making. Fracture union occurred in 97% of our patients. Complications were frequent, and a reoperation was required in 19% of the patients. More than half of the patients in our study had a loose humeral component that required revision.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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