Validation of a new classification for periprosthetic shoulder fractures

Kirchhoff, Chlodwig; Beirer, Marc; Brunner, U.; Buchholz, Arne; Biberthaler, Peter; Crönlein, Moritz

doi:10.1007/s00264-018-3774-5

Cited by 20 publications

(30 citation statements)

References 26 publications

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“…The management of prosthetic joint infections is still controversial with varying methods outlined in the literature. Surgeons must take multiple factors into account when determining treatment protocols including patient comorbidities, the risk of missing subclinical indolent infections, [77]. Overall union rate after surgery for periprosthetic humerus fractures is high, with one series reporting 97% union rate in 36 patients treated either with revision arthroplasty or ORIF.…”

Section: Periprosthetic Joint Infectionmentioning

confidence: 99%

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Failed Reverse Shoulder Arthroplasty and Recommendations for Revision

Markes

Cheung

Benjamin

2020

Curr Rev Musculoskelet Med

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Purpose of Review The most common complications warranting revision consideration in reverse shoulder arthroplasty (RSA) include instability and its associated causes: infection, periprosthetic fracture, and glenoid baseplate loosening. Management of complications can be challenging and the nuances of treatment are still being elucidated. The focus of this paper is to review the treatment of the failed RSA and discuss evidence-based recommendations for revision. Recent Findings The most common complications requiring revision RSA are instability and infection. The causes for instability can be subdivided into three main subcategories: loss of compression, loss of containment, and impingement. Loss of compression is further broken down into 6 subcategories revolving around abnormal prosthesis positioning, undersized prostheses, or intrinsic soft-tissue tension loss leading to instability. Periprosthetic infection can also lead to instability, yet the most appropriate management for infected RSA remains controversial. Summary Restoring stability by maximizing deltoid and soft tissue tension while avoiding impingement revolves around three basic methods: (1) lateralizing and/or upsizing the glenosphere to an inferior position on the glenoid, (2) use of a more constrained polyethylene insert, and (3) distalizing the humerus by increasing the polyethylene thickness and/or the thickness of the humeral tray. Management of periprosthetic joint infection can be performed in one-stage, two-stage, or "three-stage" procedures all showing good outcomes with two-stage procedures being the most commonly performed. However, persistent positive culture with propriobacterium acnes can occur in up to 25% of cases. In order to limit the associated morbidity from failed revision reverse shoulder arthroplasty, continued research on best management of associated complications is warranted.

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Section: Periprosthetic Joint Infectionmentioning

confidence: 99%

“…Kirchhoff classification system for periprosthetic humerus fractures[77]. Image adapted from Gebrelul et al[76•] …”

mentioning

confidence: 99%

Failed Reverse Shoulder Arthroplasty and Recommendations for Revision

Markes

Cheung

Benjamin

2020

Curr Rev Musculoskelet Med

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“…Depending on the location and morphology of the fracture, different classifications have been proposed; however, best treatment protocols are still debated. 10 , 15 …”

Section: Introductionmentioning

confidence: 99%

“…For these reasons, further classification has been proposed according to typology of the prosthesis. 17 …”

Section: Introductionmentioning

confidence: 99%

A Long-Term Follow-Up of Post-Operative Periprosthetic Humeral Fracture in Shoulder Arthroplasty

Novi

Porcellini

Donà

et al. 2021

Geriatr Orthop Surg Rehabil

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Background During the last decades, the growing number of shoulder replacement has increased the associated complications. Periprosthetic fractures have a low incidence but can be a severe clinical condition, especially in elderly population. There are still no guidelines to define the best treatment protocol for post-operative periprosthetic humeral fractures. Factors associated to these fractures and consequently the decision-making for the best treatment seem to be patient-related but also correlated with the type of implant. The aim of this study is to analyze the patient’s risk factors, fracture pattern, implant type and treatment, evaluating the outcome with a long-term follow-up. Methods A retrospective study was performed on more than 2700 shoulder prostheses implanted over 10 years in two specialized centers, identifying 19 patients who underwent surgery for post-operative periprosthetic fracture. Gender, age, comorbidities, type of prosthetic implant, type of fracture, and cortical index of each patient were evaluated. All patients underwent surgery and were evaluated with a mean follow-up of 5 years with radiographic controls and functional assessment with the Constant–Murley score. Results Complete healing was achieved in 18 of 19 patients. All patients presented a lower Constant–Murley score than the pre-fracture score, there were no significant differences between prosthetic implants, and the cortical index was lower than the threshold level in more than 60% of cases. Conclusion The results of this study showed that a correct preoperative planning is essential to evaluate the type of implant and possible signs of stem mobilization. With a stable stem, it is preferable to maintain it and proceed to a synthesis. The decision process is more complex in periprosthetic fractures with a reduced cortical index, when some radiolucency lines are present in stems with high primary stability, because it is not always indicative of an unstable stem. Level of Evidence Therapeutic III

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“…The recommendations vary from nonoperative management to open reduction and internal fixation (ORIF) to revision arthroplasty [16]. There are various classification systems for periprosthetic shoulder fractures, the latest of which also provides a structured treatment algorithm, is published and validated by Kirchhoff et al [17,18]. All their reported cases are postoperative fractures and an algorithm for intraoperative fractures is not available.…”

Section: Introductionmentioning

confidence: 99%

Inadvertent, intraoperative, non- to minimally displaced periprosthetic humeral shaft fractures in RTSA do not affect the clinical and radiographic short-term outcome

Hasler

Kriechling

Passaplan

et al. 2021

Arch Orthop Trauma Surg

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Introduction Little information is available on the clinical and radiographic outcome of intraoperative, non- to minimally displaced humeral fractures that occur during implantation of a stemmed, reverse shoulder prosthesis but are only recognized on routine postoperative radiographs. The goal of this study is to report the clinical and radiographic outcome for this rarely reported fracture type. Materials and methods 39 conservatively treated non- to minimally displaced intraoperative periprosthetic humeral fractures after stemmed RTSA were detected from our radiographic database between 1.1.2006 and 31.1.2018. Exclusion criteria were lack of patient consent, preoperative humeral fracture, and revision arthroplasties. Clinical (absolute and relative Constant score, the Subjective Shoulder Value) and radiographic (conventional radiographs) assessment was performed preoperatively, at 6 weeks (only radiographically) and at latest follow-up with a minimum follow-up of 2 years. Results 35 patient’s with a mean age of 72 years (range 32–88, SD ± 11 years) and a mean follow-up of 53 months (range 24–124, SD ± 31) were included in the study. At latest follow-up, all clinical outcome parameters except external rotation improved significantly. A complication rate of 17% (n:6) was recorded. At 6 weeks after the index surgery, none of the radiographs showed a fracture displacement or a sintering of the stem. At latest follow-up, all fractures were healed and no stem loosening was observed in any of the shoulders. Conclusions Non- to minimally displaced intraoperative periprosthetic humeral fractures in RTSA have an incidence of about 5% in this series of mainly uncemented press-fit stems. They generally heal without any further treatment and are not associated with stem loosening or compromise the clinical outcome after primary RTSA. Except slight restriction in the postoperative rehabilitation protocol, no further attention or action is needed.

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Validation of a new classification for periprosthetic shoulder fractures

Abstract: The newly developed six-step classification is easy to utilise and extends the pre-existing classification systems in terms of clinically-relevant information. This classification should serve as a simple tool for the surgeon to consider the optimal treatment for his patients.

Cited by 20 publications

References 26 publications

Failed Reverse Shoulder Arthroplasty and Recommendations for Revision

Failed Reverse Shoulder Arthroplasty and Recommendations for Revision

A Long-Term Follow-Up of Post-Operative Periprosthetic Humeral Fracture in Shoulder Arthroplasty

Inadvertent, intraoperative, non- to minimally displaced periprosthetic humeral shaft fractures in RTSA do not affect the clinical and radiographic short-term outcome

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