The Wright and Cofield classification system can be used for postoperative periprosthetic humeral fractures. Humeral periprosthetic fractures may be intraoperative (~60%) or postoperative (~40%) shoulder arthroplasty complications, which can lead to loosening and migration of the prosthesis 1,3.
On this page:
Usage
The Wright and Cofield classification system is the most commonly used (c. 2023) and classifies by the relationship of the fracture to the distal tip of the prosthesis 2. Other classification systems for postoperative periprosthetic humeral fractures include 2,3:
Campbel et al.: classifies by humeral fracture location (i.e. tuberosity, metaphysis, shaft)
Groh et al.: also classifies by relation to the distal tip of the prosthesis but in a different pattern to Wright and Cofield
Kirchhoff et al.: classifies by implant type and stability, fracture pattern and location, rotator cuff status
Classification
This classification is based on the fracture pattern in relation to the distal tip of the prosthesis 1:
type A: centered near the tip and extend proximally
type B: centered at the tip with variable extension distally
type C: located distal to the tip of the stem
Treatment and prognosis
Treatment involves open reduction-internal fixation (ORIF) or revision shoulder arthroplasty depending on the location of the fracture and stability of the prosthesis. It can be done with plates and screws fixation, plates and cerclage wire, or plates and screws associated with cerclages. Locked screws promote rotational control, and cerclage increases the stability of the construct at the stem level 1.
Unable to process the form. Check for errors and try again.