What can you tell me about fractures of the arm bone after shoulder replacement? My mother-in-law is telling us that’s what she has. We live on the other side of the United States from her, so we are trying to figure out what her options are and whether or not we need to get there quickly.

You will likely need more information either from your mother-in-law or directly from her doctor (this requires her giving written permission for you to communicate with her physician).

Anyone who gets a shoulder replacement is told there can be unexpected complications that develop either during or after the surgery. One of those problems may be a humeral fracture around the prosthesis (or implant). The humerus is the upper arm bone. A fracture of the humeral bone next to the implant is called a periprosthetic fracture.

Treatment of these fractures requires surgery either by removing the implant and replacing it or using hardware to hold everything together until healing takes place. This second option is a surgical procedure referred to as open reduction and internal fixation (ORIF).

Treatment decisions are affected by many factors such as the patient’s age, general health, smoking/tobacco use history, and the presence of other problems such as heart disease, diabetes, high blood pressure, etc.

The type of shoulder replacement implant can make a difference, too. She may have the traditional shoulder replacement where the humeral component replaces the humeral head, or the ball of the joint. The glenoid component replaces the socket of the shoulder, which is actually part of the scapula. In the “normal” artificial shoulder prosthesis, the glenoid prosthesis is a shallow socket made of plastic and the humeral component is a metal stem attached to a metal ball that nearly matches the anatomy of the normal shoulder.

Or she may have a reverse shoulder prosthesis. In the reverse shoulder replacement, the ball and the socket are reversed. Patients who have a severely damaged (and irreparable) rotator cuff are the most likely candidates for the reverse arthroplasty. This type of shoulder replacement provides pain relief as well as a stable, functional shoulder.

X-rays will provide the surgeon with some details about the location, type, and severity of bone fracture. This information in conjunction with type of implant and patient characteristics all factor into the final treatment decision-making process.