Management of periprosthetic humeral fractures after shoulder arthroplasty: A case report on open reduction and internal fixation with strut allograft

This case report details the management of a periprosthetic humeral shaft fracture treated by open reduction and internal fixation (ORIF) with a strut allograft. To date, only 50 patients treated with strut allografts for periprosthetic humeral fractures are documented in the literature. Four case series, two retrospective reviews, and one prospective review have been analyzed. Of these, four studies (40 patients) used strut allografts with plates, and three studies (10 patients) used strut allografts with cerclage alone. Fracture union occurred between 3 and 7 months postoperatively. This is the first case report of such a fracture treated with a strut allograft and documented follow-up nearing two years. A 77-year-old man with multiple prior right shoulder surgeries, including reverse shoulder arthroplasty in 2017, sustained a proximal periprosthetic humeral fracture in 2023 after a fall. Initial ORIF with a long plate failed due to early loss of reduction. A revision procedure was performed using a longitudinally split fibular strut allograft, with halves placed medially and anteriorly, secured by fiber wires and plate fixation. At two years post-op, the patient was pain-free and functional, with radiographs showing fracture consolidation and graft integration. Seven studies have reported outcomes of strut allografts in periprosthetic humeral fractures. Only one compared ORIF with and without allograft, finding no outcome difference. Strut allografts are a valuable option for failed ORIF, providing both biological and mechanical stability. Level IV. • First case report of periprosthetic humeral fracture treated with strut allograft and followed for nearly two years. • Successful revision surgery using fibular strut allograft after failed ORIF, achieving fracture union and graft incorporation. • Excellent functional outcome with a Constant Shoulder Score of 84, surpassing previously reported averages. • Strut allograft provided both mechanical and biological stability in a complex revision shoulder arthroplasty case.