Surgical Fixation of Distal Periprosthetic Humerus Fractures using a Distal Femoral Locking Plate: Surgical Technique and Report of Three Cases

Luzzi, Andrew; Schoch, Bradley; Horneff  III, J. Gabriel; Lazarus, Mark

doi:10.22034/ijos.2020.121371

Surgical Fixation of Distal Periprosthetic Humerus Fractures using a Distal Femoral Locking Plate: Surgical Technique and Report of Three Cases

Authors

Andrew Luzzi

Bradley Schoch

J. Gabriel Horneff III

Mark Lazarus

https://doi.org/10.22034/ijos.2020.121371

Abstract

Periprosthetic fractures about the humerus are a rare but difficult complication of shoulder arthroplasty, occurring in up to 3% of cases. Depending on the fracture pattern, open reduction and internal fixation (ORIF) may be used to definitively treat these injuries. This article demonstrates a new technique that uses a distal femoral locking plate to maximize bony fixation of such periprosthetic humeral fractures. Between November 2008 and July 2016, three patients with periprosthetic humerus fractures were treated with open reduction internal fixation using a distal femoral locking plate. All patients were followed until radiographic :union:. Fractures occurred at a mean of 5.2 years after arthroplasty (range, 1 to 7.5 years). Two of the fractures were classified as Wright-Cofield Type C and one fracture was Wright-Cofield Type B. Surgical fixation was performed at a mean of 6 days after fracture. All were treated with a fixed angle distal femoral locking plate. Healing was confirmed radiographically for all three patients at a mean of 11.8 months (range 3 to 28.5 months). No patient required reoperation. Obtaining adequate bony fixation around periprosthetic humerus fractures remains challenging. The use of a distal femoral locking plate may be helpful in patients with long stem prostheses which require increased distal fixation.
Level of Evidence: Level IV

Keywords

Keywords: Humerus

Periprosthetic Fracture

Internal Fixators

1. Steinmann SP, Cheung EV. Treatment of periprosthetic
humerus fractures associated with shoulder
arthroplasty. J Am Acad Orthop Surg. 2008;16(4):199-
207.
2. Seybold D, Citak M, Konigshausen M, Gessmann J,
Schildhauer TA. Combining of small fragment screws
and large fragment plates for open reduction and
internal fixation of periprosthetic humeral fractures. Int
J Shoulder Surg. 2011;5(4):105-7.
3. Boskey AL, Coleman R. Aging and bone. J Dent Res.
2010;89(12):1333-48.
4. Johanson NA, Litrenta J, Zampini JM, Kleinbart F,
Goldman HM. Surgical treatment options in patients
with impaired bone quality. Clin Orthop Relat Res.
2011;469(8):2237-47.
5. Kumar S, Sperling JW, Haidukewych GH, Cofield RH.
Periprosthetic humeral fractures after shoulder
arthroplasty. J Bone Joint Surg Am. 2004;86-a(4):680-9.
6. Greiner S, Stein V, Scheibel M. Periprosthetic humeral
fractures after shoulder and elbow arthroplasty. Acta
Chir Orthop Traumatol Cech. 2011;78(6):490-500.
7. Christoforakis JJ, Sadiq S, Evans MJ. Use of a Dall-
Miles plate and cables for the fixation of a
periprosthetic humeral fracture. Acta Orthop Belg.
2003;69(6):562-5.
8. Martinez AA, Calvo A, Cuenca J, Herrera A. Internal
fixation and strut allograft augmentation for
periprosthetic humeral fractures. J Orthop Surg (Hong
Kong). 2011;19(2):191-3.
9. Proubasta I, Itarte J, Lamas C, Escriba I. Mennen plate
fixation for the treatment of periprosthetic fracture of
the humeral shaft: A case report. The Internet Journal of
Orthopedic Surgery. 2004;2(2).
10. Schoch B, Mehta S, Namdari S. Surgical fixation of
periprosthetic humerus fractures using an extension
plate: Surgical technique and report of 5 cases. J Orthop
Trauma. 2017;31(12):e432-e5.
11. Gerwin M, Hotchkiss RN, Weiland AJ. Alternative
operative exposures of the posterior aspect of the
humeral diaphysis with reference to the radial nerve. J
Bone Joint Surg Am. 1996;78(11):1690-5.
12. Mineo GV, Accetta R, Franceschini M, Pedrotti
Dell'Acqua G, Calori GM, Meersseman A. Management
of shoulder periprosthetic fractures: our institutional
experience and review of the literature. Injury. 2013;44
Suppl 1:S82-5.