28/02/2026
Periprosthetic Humeral Fractures: The Importance of Surgical Restraint
A recent case 29/M - periprosthetic fracture of the humeral shaft + NV intact PMH - severe open intercondylar distal humerus fracture (June 2025) - ORIF Recovering well when a fall with axial loading through the hand resulted in a new fracture occurring around existing implants.
The Problems Beyond the Fracture
1. previously healed (or healing) bone,
2. altered stress distribution from existing implants + screws in the way of reduction
3. compromised soft tissues,
4. and the functional trajectory already established for the patient.
The central dilemma was familiar:
Remove hardware and reconstruct extensively — or preserve what is already working?
Lessons from the Literature
Current evidence increasingly supports a measured approach:
- Operative fixation achieves union rates approaching 90–95% in most reported series.
- Extensive revision procedures, although sometimes necessary, carry complication rates reported between 30–60%.
- Implant-retaining strategies using bridging fixation have shown reliable union while reducing biological insult and operative morbidity.
The literature repeatedly suggests that success in these injuries is less about implant choice and more about respecting mechanical principles while preserving biology.
Surgical Strategy
The operative plan therefore focused on continuity rather than escalation:
retention of stable prior fixation, avoidance of unnecessary implant removal,
creation of a construct that bypassed stress risers, and minimization of additional soft-tissue trauma.
Management - Posterior approach + posterior plate removed + along with screws from the medial plate abutting the reduction + fixed with a long locking plate
Outcome
The fracture reduction turned out robust, ROM started active and passive while limiting external rotation without losing the gains achieved after the initial injury.
Key learning: Periprosthetic fractures are problems of strategy, not just fixation.
Interested to hear how colleagues approach implant retention vs revision in similar situations.
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