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Findings
• Initial studies demonstrate a left shoulder hemiarthroplasty with superior and
anterior positioning of the component. CT study also demonstrates
disruption through the base of the coracoid. Subsequent radiographs
demonstrate a reverse type total shoulder arthroplasty which shows
anatomic positioning on CT, particularly as relates to the metalglene or base
plate to the native glenoid. Repeat CT demonstrates on the scout topogram,
the often very complex nature of these cases with multiple sites of pathology.
The repeat CT demonstrates a very subtle defect of the scapular spine.
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Diagnosis: Complications of shoulder arthroplasty with multiple
periprosthetic fractures
• This case demonstrates only a couple of the complications that can come
in the setting of joint arthroplasty and especially in this case shoulder
arthroplasty. Hemiarthroplasties are known to be at risk for progression of
instability often related to progressed degeneration and tearing of the
rotator cuff as seen in this case. In addition, patients often suffer from
propagation of arthritis necessitating total shoulder arthroplasty as seen in
this case. One other complication related to progressive disease of the
cuff is a loss of the acromiohumeral interval yielding increased stress on
the coracoacromial arch and precipiating fractures as in this case of the
coracoid.
• Total shoulder arthroplasties and in particular in this case, reverse total
shoulder arthroplasties, can have complications. Scapular notching,
difficulty in seating the base plate, dissociation, infection, and loosening
are well known complications. In addition, particularly in the setting of the
reverse TSA, acromial and scapular spine fractures are becoming more
recognized. These fractures may of course be painful but may necessitate
additional fixation as well.
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Resources
• Crosby LA, Hamilton A, Twiss T (2011) Scapula fractures after reverse
total shoulder arthroplasty: classification and treatment. Clin Orthop Relat
Res 469(9):2544–2549.
• Levine WN, Fischer CR, Nguyen D, Flatow EL, Ahmad CS, Bigliani LU.
Long-term follow-up of shoulder hemiarthroplasty for glenohumeral
osteoarthritis. J Bone Joint Surg Am. 2012 Nov 21;94.
• Scarlat MM. Complications with reverse total shoulder arthroplasty and
recent evolutions. Int Orthop. 2013 Mar 3.
• Special thanks to Frank Cordasco, MD and Larry Gulotta, MD for their
insight and assistance on this case.
