OTSR - 2026-09-12 - Journal Article
Humeral Fractures After Reverse Total Shoulder Arthroplasty: Functional Outcomes and Complications.
Bahu E, Saab M, Chantelot C, Lancigu R, Peduzzi L, Jacquet J, Obert L, Mansat P
Topics
Key Takeaway
Prosthetic revision for periprosthetic humeral fracture after rTSA carries a 3.7-fold higher complication risk versus nonoperative management with no difference in ASES, SSV, or Constant scores at mean 42-month follow-up.
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Summary
This multicenter retrospective study compared nonoperative treatment, osteosynthesis, and prosthetic revision for periprosthetic humeral fractures after rTSA in 121 patients across 14 French centers, classified by Wright-Cofield and Campbell systems. Prosthetic revision increased complication risk 3.7-fold (95% CI 1.26–12.2, p=0.022) and osteosynthesis 2.5-fold (95% CI 0.87–7.77, p=0.1) versus nonoperative care. Functional scores (ASES, SSV, Constant) did not differ significantly across groups at final follow-up, though functional data were available for only 64 of 121 patients.
Key Limitation
Functional outcome data were missing for 47% of patients, and the nonoperative group likely contained a disproportionate share of lower-demand or less-displaced fractures, making direct group comparisons susceptible to indication bias.
Original Abstract
INTRODUCTION
Periprosthetic humeral fracture is one of the major complications of shoulder arthroplasty. Optimal therapeutic management of this complication remains debated across treatment modalities. The aim of this study was to determine the most appropriate strategy by comparing functional outcomes and complications among the different treatments for humeral fractures occurring after reverse total shoulder arthroplasty (rTSA).
HYPOTHESES
There were no differences in complication rates or functional outcomes between nonoperative treatment and surgical management (osteosynthesis or prosthetic revision) of periprosthetic humeral fractures.
PATIENTS AND METHODS
Between 2005 and 2024, across 14 French centers, 121 patients presenting with a periprosthetic humeral fracture were evaluated as part of the 2024 symposium of the French Society of Orthopaedic and Trauma Surgery (SOFCOT). Fractures were radiologically classified according to the Wright-Cofield and Campbell classifications. Demographic characteristics and treatment strategies were collected. Mean follow-up was 42 ± 42 months (range, 0-169). Complications at final follow-up were analyzed and compared across treatments (56 osteosyntheses, 34 prosthetic revisions, 31 nonoperative treatments). Functional scores-Subjective Shoulder Value (SSV), American Shoulder and Elbow Surgeons (ASES), and Constant-were available for 64 patients (31 osteosyntheses, 15 revisions, 18 nonoperative).
RESULTS
Surgical treatments had a higher complication rate than nonoperative management (p = 0.055). Compared with nonoperative treatment, prosthetic revision increased the risk of complications by a factor of 3.7, 95% CI [1.26-12.2] (p = 0.022), whereas osteosynthesis increased complication risk by a factor of 2.5, 95% CI [0.874-7.77], though not significantly (p = 0.1). Functional outcomes did not differ significantly among treatment groups at final follow-up (p = 0.91, 0.256, and 0.92 for ASES, SSV, and Constant scores, respectively).
DISCUSSION
Surgical treatment of humeral fractures occurring on reverse total shoulder arthroplasties showed a substantially higher risk of complications without functional benefit at final follow-up when compared with nonoperative care. These findings highlight the need to carefully balance risks and benefits when considering surgical management of periprosthetic humeral fractures.
LEVEL OF EVIDENCE
IV; Retrospective clinical study.