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Chang HH, Lim JR, Yoon TH, Chun YM, Kim HS. The Treatment of Periprosthetic Fracture Revision of the Humerus with "Bamboo Support" Structural Allograft Technique-Atrophic Non-Union of a Post-Operative Periprosthetic Fracture after Reverse Total Shoulder Arthroplasty: A Case Report. J Clin Med 2024; 13:825. [PMID: 38337518 PMCID: PMC10856593 DOI: 10.3390/jcm13030825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/19/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Periprosthetic fractures are a serious complication of joint replacement surgery. With the growing prevalence of reverse total shoulder arthroplasty (RTSA), the incidence of relatively uncommon periprosthetic humeral fractures has increased. Here, we present the unique case of a 74-year-old woman who developed atrophic non-union after plate osteosynthesis for a periprosthetic fracture associated with RTSA. Fixation failure was evident 3 months after the surgical intervention; the patient underwent a 3-month course of arm sling immobilization. However, bone resorption continued, and varus angulation of the fracture developed. In this case, surgical strategy involved the use of long proximal humerus internal locked system plate (DePuy Synthes, Paoli, PA, USA), augmented with autologous iliac bone graft and allogenic humerus structural bone graft with the "bamboo support technique", fixed with Cable System (DePuy Synthes, Paoli, PA, USA). No reports have addressed the management of failed periprosthetic fractures using allogeneic humeral strut bone grafts. This report aims to fill the gap by presenting a novel surgical technique for the management of periprosthetic fractures associated with RTSA in case of treatment failure.
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Affiliation(s)
- Hsien-Hao Chang
- Department of Orthopaedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea;
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Joon-Ryul Lim
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Tae-Hwan Yoon
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
- Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Yong-Min Chun
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Hyoung-Sik Kim
- Department of Orthopaedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea;
- Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
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Wiethölter M, Akgün D, Plachel F, Minkus M, Karczewski D, Braun K, Thiele K, Becker L, Stöckle U, Moroder P. Inter-Observer and Intra-Observer Reliability Assessment of the Established Classification Systems for Periprosthetic Shoulder Fractures. J Clin Med 2023; 12:jcm12093168. [PMID: 37176610 PMCID: PMC10179361 DOI: 10.3390/jcm12093168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/17/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
This study evaluated the reliability and comprehensiveness of the Unified classification system (UCPF), Wright & Cofield, Worland and Kirchhoff classifications and related treatment recommendations for periprosthetic shoulder fractures (PPSFx). Two shoulder arthroplasty specialists (experts) and two orthopaedic residents (non-experts) assessed 20 humeral-sided and five scapula-sided cases of PPSFx. We used the unweighted Cohen's Kappa (κ) for measuring the intra-observer reliability and Krippendorff's alpha (α) for measuring the inter-observer reliability. The inter-rater reliabilities for the Wright & Cofield and Worland classifications were substantial for all groups. The expert and non-expert groups for UCPF also showed substantial inter-rater agreement. The all-rater group for the UCPF and the expert and non-expert group for the Kirchhoff classification revealed moderate inter-rater reliability. For the Kirchhoff classification, only fair inter-rater reliability was found for the non-expert group. Almost perfect intra-rater reliability was measured for all groups of the Wright & Cofield classification and the all-rater and expert groups of the UCPF. All groups of the Kirchhoff and Worland classifications and the group of non-experts for the UCPF had substantial intra-rater reliabilities. Regarding treatment recommendations, substantial inter-rater and moderate intra-rater reliabilities were found. Simple classification systems for PPSFx (Wright & Cofield, Worland) show the highest inter- and intra-observer reliability but lack comprehensiveness as they fail to describe scapula-sided fractures. The complex Kirchhoff classification shows limited reliability. The UCPF seems to offer an acceptable combination of comprehensiveness and reliability.
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Affiliation(s)
- Mats Wiethölter
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, 48149 Münster, Germany
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, 13353 Berlin, Germany
| | - Doruk Akgün
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, 13353 Berlin, Germany
| | - Fabian Plachel
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, 13353 Berlin, Germany
| | - Marvin Minkus
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, 13353 Berlin, Germany
| | - Daniel Karczewski
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, 13353 Berlin, Germany
| | - Karl Braun
- Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Kathi Thiele
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, 13353 Berlin, Germany
| | - Luis Becker
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, 13353 Berlin, Germany
| | - Ulrich Stöckle
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, 13353 Berlin, Germany
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