{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T02:59:26Z","timestamp":1783479566381,"version":"3.55.0"},"reference-count":18,"publisher":"British Editorial Society of Bone & Joint Surgery","issue":"10","license":[{"start":{"date-parts":[[2012,10,1]],"date-time":"2012-10-01T00:00:00Z","timestamp":1349049600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/online.boneandjoint.org.uk\/TDM"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery. British volume"],"published-print":{"date-parts":[[2012,10]]},"abstract":"<jats:p> There is little information about the management of peri-prosthetic fracture of the humerus after total shoulder replacement (TSR). This is a retrospective review of 22 patients who underwent a revision of their original shoulder replacement for peri-prosthetic fracture of the humerus with bone loss and\/or loose components. There were 20 women and two men with a mean age of 75 years (61 to 90) and a mean follow-up 42 months (12 to 91): 16 of these had undergone a previous revision TSR. Of the 22 patients, 12 were treated with a long-stemmed humeral component that bypassed the fracture. All their fractures united after a mean of 27 weeks (13 to 94). Eight patients underwent resection of the proximal humerus with endoprosthetic replacement to the level of the fracture. Two patients were managed with a clam-shell prosthesis that retained the original components. The mean Oxford shoulder score (OSS) of the original TSRs before peri-prosthetic fracture was 33 (14 to 48). The mean OSS after revision for fracture was 25 (9 to 31). Kaplan-Meier survival using re-intervention for any reason as the endpoint was 91% (95% confidence interval (CI) 68 to 98) and 60% (95% CI 30 to 80) at one and five years, respectively. <\/jats:p><jats:p> There were two revisions for dislocation of the humeral head, one open reduction for modular humeral component dissociation, one internal fixation for nonunion, one trimming of a prominent screw and one re-cementation for aseptic loosening complicated by infection, ultimately requiring excision arthroplasty. Two patients sustained nerve palsies. <\/jats:p><jats:p> Revision TSR after a peri-prosthetic humeral fracture associated with bone loss and\/or loose components is a salvage procedure that can provide a stable platform for elbow and hand function. Good rates of union can be achieved using a stem that bypasses the fracture. There is a high rate of complications and function is not as good as with the original replacement. <\/jats:p>","DOI":"10.1302\/0301-620x.94b10.29248","type":"journal-article","created":{"date-parts":[[2012,9,27]],"date-time":"2012-09-27T01:57:24Z","timestamp":1348711044000},"page":"1382-1389","source":"Crossref","is-referenced-by-count":28,"title":["Management of peri-prosthetic fracture of the humerus with severe bone loss and loosening of the humeral component after total shoulder replacement"],"prefix":"10.1302","volume":"94-B","author":[{"given":"M. D.","family":"Sewell","sequence":"first","affiliation":[{"name":"The Royal National Orthopaedic Hospital, Brockley\rHill, Stanmore, Middlesex\rHA7 4LP, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. N.","family":"Kang","sequence":"additional","affiliation":[{"name":"The Royal National Orthopaedic Hospital, Brockley\rHill, Stanmore, Middlesex\rHA7 4LP, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N.","family":"Al-Hadithy","sequence":"additional","affiliation":[{"name":"The Royal National Orthopaedic Hospital, Brockley\rHill, Stanmore, Middlesex\rHA7 4LP, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. S.","family":"Higgs","sequence":"additional","affiliation":[{"name":"The Royal National Orthopaedic Hospital, Brockley\rHill, Stanmore, Middlesex\rHA7 4LP, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.","family":"Bayley","sequence":"additional","affiliation":[{"name":"The Royal National Orthopaedic Hospital, Brockley\rHill, Stanmore, Middlesex\rHA7 4LP, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Falworth","sequence":"additional","affiliation":[{"name":"The Royal National Orthopaedic Hospital, Brockley\rHill, Stanmore, Middlesex\rHA7 4LP, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. M.","family":"Lambert","sequence":"additional","affiliation":[{"name":"The Royal National Orthopaedic Hospital, Brockley\rHill, Stanmore, Middlesex\rHA7 4LP, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"42","reference":[{"key":"r1","doi-asserted-by":"publisher","DOI":"10.1067\/mse.2003.18"},{"key":"r2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2005.05.005"},{"key":"r3","doi-asserted-by":"publisher","DOI":"10.1016\/S0030-5898(05)70085-7"},{"key":"r4","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200404000-00003"},{"key":"r5","doi-asserted-by":"publisher","DOI":"10.1016\/S1058-2746(99)90095-2"},{"key":"r6","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199509000-00008"},{"key":"r7","doi-asserted-by":"publisher","DOI":"10.5435\/00124635-200804000-00003"},{"key":"r8","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199274100-00008"},{"key":"r9","doi-asserted-by":"publisher","DOI":"10.1016\/S1058-2746(98)90033-7"},{"key":"r10","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-008-0746-z"},{"key":"r11","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.78B4.0780593"},{"key":"r12","doi-asserted-by":"crossref","unstructured":"Gohlke F, Rolf O. 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