Stemless total shoulder arthroplasty for the treatment of post-traumatic fracture sequelae: A case report
DOI:
https://doi.org/10.14748/wtzqsv18Keywords:
proximal humerus fracture, stemless arthroplasty, avascular necrosis, PHILOS plate, SPADI, rehabilitationAbstract
Introduction:
Proximal humerus fractures are among the most common fractures in adults. Avascular necrosis (AVN) remains a serious complication in complex fractures, with an incidence of 30–40% in three- and four-part patterns. Stemless shoulder arthroplasty represents a modern bone-preserving surgical solution.
Materials and Methods:
A 36-year-old male with a four-part proximal humerus fracture-dislocation following a motorcycle accident was evaluated. Diagnosis was confirmed by radiography and 3D CT. Functional outcome was assessed using the Shoulder Pain and Disability Index (SPADI) and goniometric ROM measurement at all follow-up intervals. Primary treatment consisted of ORIF with a PHILOS locking plate, augmented by autologous tricortical iliac crest bone graft. Following AVN development and hardware removal, stemless shoulder hemiarthroplasty was performed. A multidisciplinary rehabilitation protocol was applied throughout.
Results:
At four-month post-arthroplasty follow-up, 3D CT confirmed anatomical implant positioning without periprosthetic osteolysis. SPADI improved by 44 points. Flexion reached 110°, abduction was 90°, and external rotation was 35°.
Conclusion:
Stemless shoulder hemiarthroplasty is a viable bone-preserving option for young, high-demand patients with post-traumatic fracture sequelae, yielding significant early functional improvement and preserving future reconstructive options.
References
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Data Availability Statement
This case report was compiled following a two-year follow-up of a patient with complete medical documentation, including serial radiographs and CT imaging of the affected region performed at the Department of Diagnostic Imaging, St. Marina University Hospital, Varna, with surgical procedures performed at the Department of Orthopaedics and Traumatology of the same institution.
