Periprosthetic fractures: Repair, revise, or treat conservatively

Periprosthetic fractures occuring in total shoulder arthroplasty (TSA) present challenges both in decision-making as well as surgical management. These fractures more frequently involve the humerus but can also occur in the scapula. In a few cases with minimal displacement conservative care may be employed. In most, however, surgical intervention is needed. Depending on the quality of the surrounding bone, the health of the patient, the stability of the existing implant, and the integrity of the surrounding soft tissues, options for management include open reduction and internal fixation, long stem intramedullary fixation with implants, bone grafting, strut and cable fixation, or a combination of all these techniques. In some cases, complete revision arthroplasty may be indicated. An approach to surgical decision-making, operative techniques and avoidance of complications will be presented.