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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.