Table 5: Advantages and disadvantages of surgical treatment options.

Surgical technique



Replace stem with one that bridges fracture

Stability of fracture site

Non-systematic approach to

fracture site

Joint approach

Increased risk of infection


Loss of bone stock Risk of glenohumeral instability

Fixation with plate and wire cerclage

Existing implants preserved

No joint approach

Wire cerclage and stem stability not always optimal Fragile bone (like a hot knife through butter)

Theoretical neurological risk due to wire cerclage Early motion not always



Novel plate-screw-stem fixation


Wire cerclage not always needed

No joint approach

Existing implants preserved

Early motion

Limited to locking stems Ideally requires a specially designed plate