[Periprosthetic glenoid and acromial fractures after primary shoulder arthroplasty : Diagnosis, treatment, and revision strategies].

Abstract

Background: Periprosthetic fractures of the glenoid and acromion are rare but clinically relevant complications following primary shoulder arthroplasty. Due to the increasing use of reverse shoulder arthroplasty, the incidence of these fractures is expected to increase.

Objective: This review aims to summarize current evidence on the pathomechanisms, diagnosis, treatment strategies, and prognostic factors of periprosthetic glenoid and acromial fractures from a trauma and orthopedic surgery perspective.

Materials and methods: A narrative review of current clinical and biomechanical literature addressing periprosthetic fractures of the glenoid, acromion, and scapular spine was conducted.

Results: Periprosthetic glenoid fractures are challenging due to limited bone stock and their close relationship to implant stability. Key decision parameters include component stability, fracture morphology, and remaining bone stock. Computed tomography is essential for diagnosis and surgical planning. Acromial and scapular spine fractures mainly occur after reverse shoulder arthroplasty, which nowadays constitutes a significant proportion of implantations; they are typically insufficiency fractures and are associated with limited functional outcomes. Conservative treatment is recommended in most cases.

Conclusion: A differentiated evaluation of periprosthetic glenoid and acromial fractures, taking into account their specific pathomechanisms, biomechanical conditions, and prognostic implications, is essential for appropriate therapeutic decision-making.