Periprosthetic humeral fractures: You're breakin' my heart

Treatment of periprosthetic humeral fractures is challenging, and there are few reports in the literature describing outcomes. Most of these fractures can be treated nonoperatively with functional bracing or casting. Failure to achieve union by 3 months, prosthetic loosening, or unacceptable alignment are indications for surgical intervention. The timing and pattern of the fracture dictate the specific type of operative management. Surgical options include internal fixation around a fixed stem with plates, screws, or cerclage cables. A long stem prosthesis may be indicated if there is loosening or the fracture is identified intraoperatively. Outcomes in the literature show mixed results with loss of motion being the most common reason for unsatisfactory outcomes.