Surgical Fixation of Distal Periprosthetic Humerus Fractures using a Distal Femoral Locking Plate: Surgical Technique and Report of Three Cases

Periprosthetic fractures about the humerus are a rare but difficult complication of shoulder arthroplasty, occurring in up to 3% of cases. Depending on the fracture pattern, open reduction and internal fixation (ORIF) may be used to definitively treat these injuries. This article demonstrates a new technique that uses a distal femoral locking plate to maximize bony fixation of such periprosthetic humeral fractures. Between November 2008 and July 2016, three patients with periprosthetic humerus fractures were treated with open reduction internal fixation using a distal femoral locking plate. All patients were followed until radiographic :union:. Fractures occurred at a mean of 5.2 years after arthroplasty (range, 1 to 7.5 years). Two of the fractures were classified as Wright-Cofield Type C and one fracture was Wright-Cofield Type B. Surgical fixation was performed at a mean of 6 days after fracture.  All were treated with a fixed angle distal femoral locking plate.  Healing was confirmed radiographically for all three patients at a mean of 11.8 months (range 3 to 28.5 months). No patient required reoperation. Obtaining adequate bony fixation around periprosthetic humerus fractures remains challenging.  The use of a distal femoral locking plate may be helpful in patients with long stem prostheses which require increased distal fixation.
Level of Evidence: Level IV