Humeral fractures after reverse total shoulder arthroplasty: functional outcomes and complications - 17/09/26

Doi : 10.1016/j.otsr.2026.104876

Edouard Bahu ^a,⁎ , Marc Saab ^a, Christophe Chantelot ^a, Romain Lancigu ^b, Lisa Peduzzi ^c, Joseph Jacquet ^c, Laurent Obert ^d, Pierre Mansat ^e

^a Department of Orthopaedic and Trauma Surgery, Lille University Hospital, 2 Avenue Émile Laine, 59000 Lille, France

^b Department of Orthopaedic and Trauma Surgery, Angers University Hospital, 4 Rue Larrey, 49933 Angers, France

^c Department of Orthopaedic and Trauma Surgery, Nancy University Hospital, 29 Avenue Marue de Lattre de Tassigny, 54000 Nancy, France

^d Department of Orthopaedic and Trauma Surgery, Besançon University Hospital, 2 Rue René Heymes, 70000 Vesoul, France

^e Department of Orthopaedic and Trauma Surgery, Toulouse University Hospital, Place du Docteur Joseph Baylac, 31300 Toulouse, France

^⁎ Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 17 September 2026

Abstract

Introduction

Periprosthetic humeral fracture is one of the major complications of shoulder arthroplasty. Optimal therapeutic management of this complication remains debated across treatment modalities. The aim of this study was to determine the most appropriate strategy by comparing functional outcomes and complications among the different treatments for humeral fractures occurring after reverse total shoulder arthroplasty (rTSA).

Hypotheses

There were no differences in complication rates or functional outcomes between nonoperative treatment and surgical management (osteosynthesis or prosthetic revision) of periprosthetic humeral fractures.

Patients and methods

Between 2005 and 2024, across 14 French centers, 121 patients presenting with a periprosthetic humeral fracture were evaluated as part of the 2024 symposium of the French Society of Orthopaedic and Trauma Surgery (SOFCOT). Fractures were radiologically classified according to the Wright-Cofield and Campbell classifications. Demographic characteristics and treatment strategies were collected. Mean follow-up was 42 ± 42 months (range, 0–169). Complications at final follow-up were analyzed and compared across treatments (56 osteosyntheses, 34 prosthetic revisions, 31 nonoperative treatments). Functional scores—Subjective Shoulder Value (SSV), American Shoulder and Elbow Surgeons (ASES), and Constant—were available for 64 patients (31 osteosyntheses, 15 revisions, 18 nonoperative).

Results

Surgical treatments had a higher complication rate than nonoperative management (p = 0.055). Compared with nonoperative treatment, prosthetic revision increased the risk of complications by a factor of 3.7, 95% CI [1.26–12.2] (p = 0.022), whereas osteosynthesis increased complication risk by a factor of 2.5, 95% CI [0.874–7.77], though not significantly (p = 0.1). Functional outcomes did not differ significantly among treatment groups at final follow-up (p = 0.91, 0.256, and 0.92 for ASES, SSV, and Constant scores, respectively).

Discussion

Surgical treatment of humeral fractures occurring on reverse total shoulder arthroplasties showed a substantially higher risk of complications without functional benefit at final follow-up when compared with nonoperative care. These findings highlight the need to carefully balance risks and benefits when considering surgical management of periprosthetic humeral fractures.