Periprosthetic fractures of shoulder endoprostheses

Periprosthetic humeral fractures are a rare occurrence, but the incidence will continue to increase in the future because of increasing numbers of shoulder arthroplasty. Intraoperative fractures can be differentiated from postoperative fractures with specific risk factors. Regarding the appropriate treatment there is little evidence in the literature with mostly only small retrospective case series. The key question for therapy is the stability of the stem and the course of the fracture area. According to the Worland classification, A- and C-type fractures with a stable stem can be treated conservatively in most cases, while B fractures with the fracture around the tip of the prosthesis require operative therapy. With a stable stem, an angular stable osteosynthesis should be performed with long plates; in case of an unstable stem, revision to a long revision stem is preferred. In the future, prospective studies with larger numbers of patient are needed to be able to develop and evaluate a valuable therapy concept for this difficult to treat fracture entity.