Intraoperative periprosthetic humeral fracture during reverse shoulder arthroplasty: a sequelae of prior biceps tenodesis

Intraoperative periprosthetic humeral fractures are a rare but debilitating complication of reverse shoulder arthroplasty and can occur during multiple stages of the procedure. Prior biceps tenodesis has been found to reduce cortical humeral strength and predispose the patient to humeral fracture. We present a case of a 68-year-old female with a previous history of biceps tenodesis due to an irreparable rotator cuff tear. Months later, and after symptoms persisted, a reverse shoulder arthroplasty was performed. During the surgery and while performing final reduction, a fracture line was observed involving the hole used for the previous tenodesis procedure. The fracture was repaired, and the patient reported favorable outcomes. We report several factors that might have contributed to sustenance of this intraoperative fracture including prior biceps tenodesis, use of a press fit humeral stem, and the sex of the patient.

Lateral decubitus or beach chair: a review of shoulder arthroscopy positions

Shoulder arthroscopy is currently one of the mainstay procedures for the treatment and diagnosis of shoulder disorders. Shoulder arthroscopy is typically performed in either the beach chair position or the lateral decubitus position. In this article, we discuss the advantages and disadvantages of each position. Of note, there currently is no consensus regarding a preferred positioning. Both the lateral decubitus and the beach chair position require the same preparations prior to the procedure. The advantages of the beach chair position are numerous, the most significant of which is the lower risk of neurovascular trauma and an easier conversion to the open approach. Conversely, the main disadvantage of this position is the risk of cerebral hypoperfusion. In regard to the lateral decubitus position, the main advantages are the lower recurrence rates and a better visualization of labral tears. The disadvantages entail an increase risk of neurovascular injury among others. This article will also briefly examine a third position, the supine position, which was recently described to combine the advantages of both the lateral decubitus and beach chair with minimal disadvantages