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Fixation failure after proximal humeral fracture osteosynthesis on osteoporotic bone

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Osteoporosis leads to low bone mass and microarchitectural deterioration of bone structure. The thinning of the cortical shell combined with less and thinner trabeculae leads to inferior mechanical properties. It is well known that untreated osteoporosis significantly increases the risk for another fracture and furthermore, aggravates fracture fixation. We present the case of a 73 year old woman with proximal humeral fracture on osteoporotic bone who underwent fracture fixation with locked intramedullary nails and later fixation failure with secondary screw migration. The patient had secondary osteoporosis due to corticosteroid (Medrol) and antimetabolite and antifolate drug (Methotrexate) for rheumatoid polyarthritis. Radiographs were analyzed for fracture classification, evaluation of fracture reduction, implant positioning and later fixation failure. Six months after fracture fixation with locked intramedullary nails the patient presented shoulder pain and movement impairment in abduction. Follow-up radiographs showed proximal screw migration due to local poor bone stock.Surgery with removal of the migrated screw was performed with the complete recovery of the patient. At the six weeks follow-up the patient presented with pain free shoulder and full range of motion restored.

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Mihaela Ecaterina Rinja, Mihnea Andrei Dumitrescu and Dan Barbu

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