Purpose: Currently, there is little information available on the management and outcome of intra-operative periprosthetic humeral fractures during shoulder arthroplasty. The purpose of this study was to report on the incidence, management, and outcome of intra-operative periprosthetic humeral fractures.

Method: Between 1980 and 2002, forty-six intra-operative periprosthetic humeral fractures occurred during shoulder arthroplasty at our institution. Thirty-six fractures occurred during primary total shoulder arthroplasty, five during primary hemiarthroplasty and four during revision shoulder arthroplasty. Twenty-one fractures involved the greater tuberosity, 16 the humeral shaft, 6 were metaphyseal and 2 fractures involved the greater tuberosity and extended to the humeral shaft. All patients were followed for a minimum of two years (mean, 7.5 years). At final follow-up, the Simple Shoulder Test (SST) and ASES scores were calculated and preoperative, postoperative, and most recent radiographs were examined for fracture healing and implant integrity.

Results: The incidence of intra-operative humerus fractures at our institution was 1.5%. All fractures healed at mean of 13 weeks (range, 6 to 56 weeks). At a mean final follow-up of 90 months (range, 25 to 194 months), the mean forward elevation was 108° and the mean external rotation was 39°. The mean SST was 6 and the mean ASES score was 61. Four patients underwent revision shoulder surgery, two for shoulder instability, one for a massive rotator cuff tear, and one for another periprosthetic humerus fracture that occurred after a fall. Complications included transient nerve injuries in six patients and four fractures displaced postoperatively which were then managed nonoperatively to healing.

Conclusion: The data from this study suggest that although intra-operative fractures have a high rate of healing, there was a significant rate of associated complications including transient nerve injuries and fracture displacement. Patients with intra-operative fractures also appear to have less forward elevation at final follow-up when compared to patients who have not sustained an intra-operative humeral fracture.

Surgical repair of rotator cuff tendon is one of the most common orthopaedic procedures performed in the United States. This prospective single-surgeon study reports the long-term results of chronic rotator cuff repair. Vigorous statistical analysis was carried out to detect any association of various outcome parameters with the exact surgical pathology.

105 consecutive shoulders (97 patients) undergoing open repair of chronic (> 3 months) rotator cuff tear between 1975 to 1983 by the senior author were recruited to the study. Pain unresponsive to nonoperative treatment was the indication for surgery. The details of patient’s medical records, radiographic data, and the operative findings were prospectively reviewed. There were 67 males and 30 females with a mean age of 58 years (range, 38 to 75). Follow-up averaged 11 years with no patients lost to follow-up. There were 16 small, 40 medium, 38 large and 11 massive tears.

Surgical repair relieved pain in 92% of patients (p< 0.0001). There was also a significant improvement in range of motion (p< 0.0001) and strength of abduction and external rotation following surgery (p< 0.0001). Return of movement and strength decreased with increasing tear size. At the latest follow-up results were rated as excellent in 68 shoulders, satisfactory in 12, and unsatisfactory in 25. 8 out of the 11 massive tears had unsatisfactory outcome. There were eight reoperations for traumatic retears.

Standard tendon repair techniques combined with adequate postoperative protection and monitored physical therapy produced consistently satisfactory results. Introduction of experimental repair methods should be confined to those patients with massive tendon tears and only then with the hope of increasing function, as pain relief is satisfactory with usual treatment methods.