Revision of a Complex Periprosthetic Humerus Fracture with Two-Thirds of Humerus Bone Loss with an Allograft-Prosthetic Composite Reverse Shoulder Arthroplasty

Shoulder arthroplasty is becoming an increasingly standard procedure in the United States. In conjunction with an aging population and increased prevalence of osteoporosis, proper management of periprosthetic humerus fractures is of great interest to orthopedic surgeons. Several periprosthetic humeral fracture classification systems take into consideration the fracture location and implant stability, but they do not address the type of bone defects or amount of bone available for revision surgery. The lack of description and guidance in the different varieties of humerus bone defects limits current classification system utility in cases with severe bone loss. There are previous case reports of revisions of periprosthetic humerus fractures with an allograft-prosthetic composite reverse total shoulder replacement. Different from previously reported cases, the case described in this article presented the treatment of a complex humerus fracture with loss of more than two-thirds of the patient’s native humerus. Due to the extensive humerus bone loss, we modified the surgical techniques previously published to allow for a successful surgery.