Conservative Treatment with Adjunctive Use of Teriparatide for Periprosthetic Humeral Fractures after Reverse Total Shoulder Arthroplasty: A Report of 6 Cases.

Abstract

Background: Periprosthetic humeral fractures (PPHFs) after reverse total shoulder arthroplasty (RTSA) are challenging complications, particularly in elderly patients with osteoporotic bone and multiple comorbidities. Although surgical treatment is commonly recommended for displaced fractures, conservative management may be preferable in high-risk patients. This study reports 6 cases of PPHF after RTSA successfully treated with conservative management incorporating adjunctive teriparatide therapy.

Methods: Six patients (mean age, 77.2 years; range, 70-87 years) who developed PPHF after RTSA were treated nonoperatively with daily subcutaneous teriparatide (20 µg) and immobilization using an abduction brace. The mean follow-up duration was 23.8 months (range, 12-36 months). Fractures were classified according to the Wright and Cofield classification system. Radiographic outcomes were assessed using serial plain radiographs. Clinical outcomes were evaluated using the visual analog scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, and active range of motion.

Results: Fracture patterns included type A (n = 1), type B (n = 4), and type C (n = 1). Radiographic union was achieved in all patients (100%) at a mean of 2.7 months (range, 2-4 months). One patient developed malunion. At final follow-up, the mean VAS pain score was 2.2 and the mean ASES score was 69.8. No teriparatide-related adverse events were observed.

Conclusions: Conservative management with adjunctive teriparatide therapy resulted in reliable radiographic union of PPHF following RTSA in selected patients. In addition to fracture classification, factors such as fracture displacement, angular deformity, implant stability, and patient-specific clinical characteristics should be carefully considered when determining treatment strategy. This approach may represent a viable alternative for elderly patients with substantial medical comorbidities in whom surgical treatment carries considerable risk.