Behrens Anna, Moronga Nick, Farkhondeh Fal Milad, Mader Konrad, Heilmann Lukas, Klatte Till Orla
EFORT Open Rev. 2025 Jun 30;10(7):534-542. doi: 10.1530/EOR-2024-0053.
Occurring in 0.5-3% of cases, periprosthetic humerus fractures pose a challenge, necessitating effective management strategies. A comprehensive review was conducted using PubMed. Used terms included 'Periprosthetic humerus fractures; complications; periprosthetic fractures shoulder arthroplasty; periprosthetic humeral fracture treatment; nerve palsy humeral revision arthroplasty; infections after shoulder arthroplasty; postoperative complications AND open reduction AND humeral fractures; allograft AND long humeral stem'. Studies were excluded if they did not meet the actual topic, included more than primary shoulder arthroplasty and/or were in non-English or non-German language. Thirty-eight papers with evidence levels ranging from two to three were selected for this review. Various classification systems have been implemented; their validation though was based on studies with only a limited number of patients. Risk factors include osteopenia/osteoporosis, rheumatoid arthritis, age, age-related lifestyle and gender. Treatment options range from conservative approaches to plate osteosynthesis or revision to a longer stem. Nevertheless, there is a lack of biomechanic studies and randomized-controlled clinical studies; hence, the evidence is low. Complications in revision arthroplasty encompass infections, nonunions, and nerve palsies, highlighting the importance of individualized treatment planning. The management of periprosthetic humeral fractures requires careful consideration of risk factors and tailored treatment plans. Existing literature relies on small case series and expert opinions, highlighting the need for further research to establish optimal treatment strategies for these challenging fractures.
人工关节周围肱骨骨折发生率为0.5%-3%，带来了挑战，需要有效的管理策略。使用PubMed进行了全面综述。使用的术语包括“人工关节周围肱骨骨折；并发症；人工关节周围骨折肩关节置换术；人工关节周围肱骨骨折治疗；肱骨翻修置换术中的神经麻痹；肩关节置换术后感染；术后并发症以及切开复位与肱骨骨折；同种异体骨与长肱骨干”。如果研究不符合实际主题、包含不止初次肩关节置换术和/或语言不是英语或德语，则将其排除。选择了38篇证据水平为二到三级的论文进行本综述。已经实施了各种分类系统；不过，它们的验证是基于患者数量有限的研究。风险因素包括骨质减少/骨质疏松、类风湿性关节炎、年龄、与年龄相关的生活方式和性别。治疗选择范围从保守方法到钢板接骨术或翻修为更长的肱骨干。然而，缺乏生物力学研究和随机对照临床研究；因此，证据不足。翻修置换术中的并发症包括感染、骨不连和神经麻痹，突出了个体化治疗计划的重要性。人工关节周围肱骨骨折的管理需要仔细考虑风险因素并制定量身定制的治疗计划。现有文献依赖于小病例系列和专家意见，突出了进一步研究以建立针对这些具有挑战性骨折的最佳治疗策略的必要性。
