Presentation
Fall from bicycle.
Patient Data
Reverse shoulder periarthroplasty fracture. No not loosening of the RSA components.
Osteosynthesis with plates, screws and cerclage.
Case Discussion
Periprosthetic fracture after reverse shoulder arthroplasty is a rare fracture and often occurs in osteoporotic patients, older persons, and among those who have a variety of comorbidities. Locked screws promote rotational control, and cerclage increases the stability of the construction.
A number of classifications are used for periprosthetic fractures of the humerus:
Wright et al.: divide fractures into 3 types (A, B, C): type A if long trait proximal to stem with a length of at least one-third of the stem size; type B if the short trait proximal to stem; type C if distal to stem.
Campbell et al.: type 1 are tuberosity fractures; type 2 proximal metaphyseal fractures; type 3 humeral shaft fractures; and type 4 fracture distal to stem.
Worland et al.: type A fractures occur about the tuberosities; type B in to the level of stem; B1 for spiral fractures with stable stem, B2 for oblique fractures about the tip of the stem (which is stable) and B3 for fractures about the stem with an unstable implant; type C fractures occur distal to stem.
Radiographer: TSRM Fabio Imola.