Humeral Fractures After Reverse Total Shoulder Arthroplasty: Functional Outcomes and Complications.

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.