This review addresses how to treat periprosthetic humerus fractures after shoulder arthroplasty. It organizes management around the Wright and Cofield classification and the status of the humeral component. The goal is a practical algorithm balancing fracture union against preservation of shoulder motion.
When you see a periprosthetic humerus fracture, your first question is not the fracture pattern but whether the humeral component is loose.
A loose stem, or a fracture that overlaps most of the prosthesis, sends you to revision with a long-stem implant. A fracture at the stem tip with a well-fixed component points toward ORIF. A fracture entirely distal to the stem is just a humeral shaft fracture and often tolerates bracing.
The Wright and Cofield A/B/C classification is the framework to memorize, and loosening is defined as a radiolucent line greater than 2 mm in three or more zones. The recurring lesson across every cited series is that fractures heal reliably but shoulders stay stiff. Secure fixation exists to permit early passive motion, which is the only lever you have against the poor functional outcomes.
This is a narrative review built on level III and IV evidence, so treat the algorithm as expert consensus rather than proven superiority of one approach.
This review addresses how to treat periprosthetic humerus fractures after shoulder arthroplasty. It organizes management around the Wright and Cofield classification and the status of the humeral component. The goal is a practical algorithm balancing fracture union against preservation of shoulder motion.
When you see a periprosthetic humerus fracture, your first question is not the fracture pattern but whether the humeral component is loose.
A loose stem, or a fracture that overlaps most of the prosthesis, sends you to revision with a long-stem implant. A fracture at the stem tip with a well-fixed component points toward ORIF. A fracture entirely distal to the stem is just a humeral shaft fracture and often tolerates bracing.
The Wright and Cofield A/B/C classification is the framework to memorize, and loosening is defined as a radiolucent line greater than 2 mm in three or more zones. The recurring lesson across every cited series is that fractures heal reliably but shoulders stay stiff. Secure fixation exists to permit early passive motion, which is the only lever you have against the poor functional outcomes.
This is a narrative review built on level III and IV evidence, so treat the algorithm as expert consensus rather than proven superiority of one approach.