9 humeral fractures occurred subsequent to 499 shoulder arthroplasties that had been performed between December 1978 and November 1987 at the Mayo Clinic. The time from the arthroplasty to the fracture averaged 39 months (range, 8 to 101 months). 7 patients were women and 2 were men, and the average age was 70 years (range, 45 to 85 years). The arthroplasties were performed for rheumatoid arthritis in 5 patients and for the sequelae of trauma in 4. 6 patients had advanced osteopenia, and 2 had had an ipsilateral total elbow arthroplasty. 6 of the fractures were centered at the tip of the prosthesis; one fracture (type A) extended proximally, and 5 (type B) did not. The 3 remaining fractures (type C) involved the humeral shaft distal to the implant and extended into the distal humeral metaphysis. 4 fractures healed with non-operative treatment. 2 fractures that had unacceptable alignment were treated successfully with operative intervention. 3 fractures that were treated with immobilization in a splint failed to heal; 2 of those fractures eventually united after a revision of the prosthesis and bone-grafting was performed, and one fracture remained ununited. Radial nerve palsy developed postoperatively in 2 patients, and it resolved within 3 months. 5 patients had poor active motion before the fracture, and 2 of them had even less motion after the fracture was treated. Our experience suggests that long oblique and spiral fractures can be successfully treated non-operatively, provided that the skeletal alignment is acceptable.(ABSTRACT TRUNCATED AT 250 WORDS)
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9 humeral fractures occurred subsequent to 499 shoulder arthroplasties that had been performed between December 1978 and November 1987 at the Mayo Clinic. The time from the arthroplasty to the fracture averaged 39 months (range, 8 to 101 months). 7 patients were women and 2 were men, and the average age was 70 years (range, 45 to 85 years). The arthroplasties were performed for rheumatoid arthritis in 5 patients and for the sequelae of trauma in 4. 6 patients had advanced osteopenia, and 2 had had an ipsilateral total elbow arthroplasty. 6 of the fractures were centered at the tip of the prosthesis; one fracture (type A) extended proximally, and 5 (type B) did not. The 3 remaining fractures (type C) involved the humeral shaft distal to the implant and extended into the distal humeral metaphysis. 4 fractures healed with non-operative treatment. 2 fractures that had unacceptable alignment were treated successfully with operative intervention. 3 fractures that were treated with immobilization in a splint failed to heal; 2 of those fractures eventually united after a revision of the prosthesis and bone-grafting was performed, and one fracture remained ununited. Radial nerve palsy developed postoperatively in 2 patients, and it resolved within 3 months. 5 patients had poor active motion before the fracture, and 2 of them had even less motion after the fracture was treated. Our experience suggests that long oblique and spiral fractures can be successfully treated non-operatively, provided that the skeletal alignment is acceptable.(ABSTRACT TRUNCATED AT 250 WORDS)
Copyright remains with the authors and publisher.