Cortical onlay strut allograft with cerclage wiring of periprosthetic fractures of the humerus without stem loosening: technique and preliminary results

The goal of this study was to describe an internal fixation technique for periprosthetic humeral fractures using a cortical onlay strut allograft stabilized with cerclage wires and to evaluate the preliminary results of this approach. An anterolateral approach was used to direct access the fracture and to protect the radial nerve. The fracture was reduced with two forceps, under visual control. The fracture was surrounded by two hemicylinder tibial allografts, placed around the humerus with no prior reaming to create a “sarcophagus” system. The allograft was as long as possible for optimal mechanical stability, without creating impingement with the glenoid and the elbow. Final fixation of the allograft was obtained with two cerclage wires. The arm was immobilized in a simple sling. Passive then active rehabilitation was begun after 1 month. Six women, mean age 74.3 ± 10.9 years old, were included in the study between 2013 and 2015 with a mean follow-up of 10 ± 2 months. Bone union was obtained in all patients after 6 months of follow-up with no recurrent fractures.