Search Results (50)

Background and Clinical Significance: Non-prosthetic peri-implant fractures (NPPIFs) are rare injuries occurring around internal fixation devices, and are distinct from periprosthetic fractures. While most studies focus on the femur, humeral NPPIFs remain poorly documented. This case illustrates a complex humeral NPPIF and highlights key surgical considerations. Case Presentation: A 62-year-old woman presented with a spiral humeral shaft fracture (AO 12B2) after a fall. Following closed reduction and antegrade intramedullary nailing, an intraoperative peri-implant fracture occurred at the distal interlocking screw. CT imaging revealed a complex fracture extending from the lateral condyle to the proximal humerus. Treatment included implant removal and open reduction with dual plate fixation—lateral distal and helically contoured proximal plates—plus cerclage bands and antibiotic-loaded beads. Recovery was uneventful, with a full range of motion achieved at six months. At one year, the DASH score and MEPS were 86 and 75, respectively. Conclusions: Humeral NPPIFs are challenging and require individualized, biomechanically sound strategies. This case reinforces the importance of intraoperative assessment and careful implant selection in humeral fracture management. Full article

Background: Distal humeral shaft fractures (DHSFs) pose surgical challenges due to the proximity to the elbow joint, limited bone stock, and the risk of radial nerve injury. This study compared clinical and radiographic outcomes of anterolateral and posterior triceps-sparing approaches to determine the most effective surgical strategy. Methods: This multicenter retrospective study included 75 patients who underwent surgery for a DHSF between 2015 and 2021, with a minimum one-year follow-up, a distal fragment ≥3 cm, and no preoperative radial nerve injury. Fifty patients underwent anterior plating via anterolateral approach, and twenty-five underwent posterior plating. Clinical and radiographic outcomes were evaluated. Results: Bone union was achieved in 74 patients (98.7%), with no significant difference between the groups (p = 0.21). The anterolateral approach resulted in a shorter operative time (116 ± 29.4 vs. 143 ± 31.4 min, p = 0.03). However, intraoperative blood loss (p = 0.36), Mayo Elbow Performance Score (p = 0.71), range of motion (p = 0.36), and complication rates (p = 0.21) were not significantly different. Two cases of transient radial nerve palsy occurred in the posterior group (p = 0.17), and four cases required implant removal due to discomfort (p = 0.18) in the anterolateral group. Conclusions: Both approaches effectively treat DHSFs with high union rates and comparable functional outcomes. However, the anterolateral approach significantly reduces operative time due to supine positioning, direct access, and avoiding radial nerve dissection. Posterior plating remains viable when stable anterior fixation is unachievable. Further studies should assess the long-term outcomes and factors influencing approach selection. Full article

Postoperative ulnar neuropathy is a common complication in patients undergoing surgery for distal humerus fractures, particularly when open reduction and internal fixation (ORIF) is performed. Objectives: This study aims to compare the rates of ulnar nerve neuropathy following classic in situ decompression versus ulnar nerve subcutaneous anterior transposition. Methods: A retrospective study was conducted, including 51 patients treated for distal humerus fractures with precontoured locking plates in our institution between 2009 and 2023, according to specific inclusion and exclusion criteria. Age, sex, ulnar neuropathy, range of motion (ROM), complications, surgical approach, and Mayo Elbow Performance Score (MEPS) were evaluated. Ulnar nerve function was graded according to modified McGowan classification. Results: Ulnar neuropathy was observed in 17 (33.3%) patients, with a higher risk in those who underwent anterior ulnar nerve transposition compared to in situ decompression (58% vs. 26%, p = 0.042). In the modified McGowan classification, 14 patients had grade 1 and 3 had grade 2 neuropathy. The overall complication rate was 49%, and the functional outcomes according to the MEPS scale showed a mean score of 81.6 (SD 17.29). The mean flexion–extension was 100.56°, and 94% of patients retained complete pronosupination. Conclusions: Our results demonstrate that routine intraoperative ulnar nerve transposition should not be performed for these fractures. Full article

Background: Curettage represents a reliable therapeutic option for large-sized benign and locally aggressive bone tumors. In cases of impending fractures, internal fixation with plates and screws can be necessary to stabilize the treated bone after curettage. Metal plates have been the only fixation devices available on the market for decades, but Carbon-fiber-reinforced polyetheretherketone (CFR-PEEK) now represents an alternative in orthopedic oncology. Methods: We reviewed our patients with benign or locally aggressive bone tumors treated with curettage and fixation with CFR-PEEK plates. Plate length and curettage technique were chosen considering the characteristics of each lesion. We recorded the size and location of the lesions, adjuvant treatments and fillers used after curettage, complications, and local recurrences. Postoperative functionality was assessed using the MSTS score. Results: Forty cases were included in our study. The tumors were located in the distal femur (19 cases), femur shaft (1), humerus (17), or proximal tibia (3). Local adjuvants were used in 20 cases. Cavities were filled with bone allografts in 30 cases and cement in 10 cases. Only four cases suffered postoperative complications, and two developed local recurrences. The mean postoperative follow-up was 29.2 months. The mean postoperative upper and lower limb MSTS was 28.0 and 26.7, respectively. Conclusions: After an accurate curettage and an adequate filling of the resulting bone gap, CFR-PEEK plates can provide good mechanical resistance, and their radio-transparency can ease the early diagnosis of local recurrences. CFR-PEEK plates should be considered in selected cases, in a personalized surgical approach. Full article

Background: Distal humerus physeal separation (DHPS) presents a rare injury type in young children often associated with misdiagnosis and delayed treatment. The aim of this study was to summarize all the available current evidence regarding the management and outcome of DHPS and determine the incidence of complications and particularly the cubitus varus deformity and avascular necrosis of the trochlea. Methods: A systematic review was conducted under the PRISMA guidelines. Medline/Pubmed, Scopus, Web of Science, and Cochrane were searched for studies dealing with children suffering from traumatic DHPS. Results: Twelve studies with a total of 257 children with DHPS were included for analysis. The mean age was 16.8 months (range: 0.1–46 months) with a mean follow-up of 37 months (range: 0.5–516 months). Non-accidental trauma was reported in 17.2% and misdiagnosis at initial assessment in 7.8%. Closed reduction and percutaneous pinning (CRPP) was the treatment of choice in 54.4%, open reduction and percutaneous pinning (ORPP) in 26.5%, closed reduction and cast immobilization (CR+cast) in 10.9%, and cast immobilization without reduction in 8.2%. The average range of extension–flexion arc was 2.1° to 127.8° (range: −10–140°). The mean Bauman’s angle was 72.4° (range: 66–79°), the mean shaft–condylar angle was 43.8° (range: 25–59°), the mean humeral length was 21.9 cm (range: 15.5–25.8 cm), and the mean carrying angle was 5.1° (range: 16° varus–19° valgus). According to Flynn’s criteria, 85.2% of cases were classified as excellent or good. The ORPP technique was associated with excellent results, while the CR+cast treatment combination was correlated with the poorest outcome (p = 0.001). Cubitus varus occurred in 18.9% (34 cases) and was highly correlated with CR+cast or cast immobilization alone without fracture reduction (p = 0.014). Avascular necrosis of the trochlea was found in 3.9% (7 cases) and was mainly apparent after cast immobilization without reduction (p < 0.001). Conclusions: Post-traumatic cubitus varus deformity may be encountered in approximately one-fifth of young children with DHPS. Surgical intervention with either CRPP or ORPP is the most effective treatment approach, leading to superior functional outcome and a lower complication rate. Full article

Background: Total elbow arthroplasty (TEA) was initially introduced for end-stage rheumatoid arthritis but has since expanded to include osteoarthritis and complex distal humerus fractures, particularly in elderly patients. Over the past two decades, TEA utilization trends have fluctuated, with a recent decline attributed to advancements in disease-modifying antirheumatic drugs. Despite its benefits, TEA presents a high complication rate, necessitating further investigation into clinical outcomes, costs, and postoperative management. Methods: This retrospective cohort study analyzed TEA procedures from 2016 to 2019 using the National Inpatient Sample (NIS) database. Patients were identified via ICD-10 codes, with elective procedures included to ensure homogeneity. This study examined temporal trends, patient demographics, comorbidities, complication rates, length of stay (LOS), and hospitalization costs. Statistical analyses included chi-square tests, t-tests, and multivariate regression to assess associations between patient characteristics and outcomes. Results: A total of 4110 TEA procedures were analyzed, revealing a 16% decline in annual volume from 2016 to 2019 (p = 0.012). The cohort had a mean age of 65.99 years, with a predominance of female (75.3%) and White (72.6%) patients. The median LOS was two days, and median hospitalization costs were USD 78,473 (IQR: 56,935–115,671 USD). The most prevalent complications included mechanical loosening (12.5%), blood loss anemia (10.6%), cardiac complications (5.7%), and prosthetic-related pain (3.3%). Multivariate analysis identified hypertension, anemia, and respiratory disease as significant predictors of adverse outcomes. Conclusions: TEA utilization has declined, likely due to medical advancements in rheumatoid arthritis management. The procedure remains associated with substantial complication rates, particularly in trauma-related cases. Findings highlight the importance of patient optimization, surgical expertise, and postoperative monitoring to improve outcomes. Full article

Background: Osteoporosis-related fragility fractures are increasing worldwide. An assessment of the prevalence of fragility fractures in Bahrain is needed to determine proper action and preventive strategies. The main objective of this study was to conduct a retrospective cross-sectional study to investigate the prevalence of fragility fractures in adult Bahraini patients. Another objective was to explore the relationship of fragility fracture risk with BMD, age, sex, BMI, vitamin D status, and therapy. Methods: To investigate the fragility fractures, we retrospectively reviewed the dual-energy X-ray absorptiometry (DEXA) data of patients who underwent scans for the diagnosis of osteoporosis between 2016 and 2018. The data were collected from four large centers in Bahrain. The patients’ medical records were reviewed for the fragility fracture data, BMD, sex, age, BMI, vitamin D status, and therapy. Results: Among a total of 4572 patients who visited the radiology departments during the 3-year study period, only 412 patients with fragility fractures were considered for the current study. The mean age of the patients in this cohort was 63.9 ± 12.2 years. There were 393 females (95.6%). Among the 431 fragility fractures, there were 175 (40.6%) belonging to three common fracture sites: vertebral (86, 20.9%), femur (60, 14.6%), and distal radius (Colles) fractures (29, 7%). Other fragility fractures were hand (7%), radius and ulna (3.7%), humerus (6.5%), tibia and fibula (5.6%), foot/ankle (27.9%), ribs (3.0%), and pelvis (1.6%). Our results revealed a significant association between the fragility fractures and BMD (χ² = 6.7, p = 0.035). We reported a significant association of fragility fracture with sex (p = 0.006) and with denosumab therapy (p < 0.001). Conclusions: This study reported a reduced BMD and an increased prevalence of fragility fractures among Bahraini subjects. The highest frequencies of fragility fractures among our cohort were foot/ankle, vertebral, and hip fractures, respectively. We showed a statistically significant association between fragility fractures and BMD. The current study indicated that not only patients with low BMD but also patients with fragility fractures were undertreated. Thus, the immediate initiation of treatment and the synthesis of local osteoporosis treatment guidelines are warranted. Full article

Background: This study aimed to investigate the fracture patterns and complexity of distal humerus fractures with high-resolution computed tomography (CT) as a function of Dual-Energy X-ray absorptiometry (DXA)-derived bone marrow density (BMD) measurements in an elderly patient cohort. Methods: A retrospective chart review was conducted on patient data collected at a Level I trauma center between January 2007 and January 2022. Inclusion criteria comprised patients aged ≥40 years with a confirmed distal humerus fracture as demonstrated by CT. Additionally, patients were included if they underwent DXA. Patient demographics and detailed information regarding the surgical treatment and trauma mechanism were retrieved from the institutional databank. Fractures were classified as either ‘low-plane’ distal humeral fractures or ‘non-low-plane’ distal humerus fractures. Furthermore, the fracture patterns were classified according to established classification systems. Intra- and postoperative complication and revision rates were analyzed. Results: A total of 41 patients (30 women; mean age 74 ± 13 years) were enrolled. Low-energy trauma was sustained by 68% of the patients. The remaining 32% of the fractures involved medium-energy trauma. A total of 62% of the patients underwent primary osteosynthesis, while 30% of patients were initially treated with an external fixator. ORIF was performed in 89% of cases and, in the majority, double-plate osteosynthesis was used (76%). An olecranon osteotomy was performed in 30% of cases. A total of 5% of cases received total elbow arthroplasty, and 10% of cases were treated conservatively. A total of 61% of patients had osteoporosis, 24% of patients had osteopenia, and 15% of patients had a normal BMD with an overall mean T-score of −2.4. Most of the fractures were complex (including 61% Type C fractures). A total of 66% of cases were considered as ‘low-plane’ fractures. Postoperative complications occurred in 11% of patients (64% of cases among ‘low-plane’ fractures). Revision surgery was required in 20% of cases. Conclusions: The consecutive series of patients showed a high incidence of ‘low-plane’ fractures. However, no statistical significance was found between the BMD and fracture complexity. The very distal ‘low-plane’ fractures showed a high complication rate, which was aggravated by osteoporotic bone conditions. These findings highlight the need for future research with larger patient samples to better understand the relationship between the BMD, fracture complexity, and outcomes in patients with ‘low-plane’ fractures in order to reduce complications and improve clinical outcomes. Full article

This study aimed to retrospectively analyze the follow-up results of cases in which the adjacent joint was preserved using a custom-made uncemented short-stem design (hollow stem) with optional external flanches in tumor endoprosthetic replacement due to bone sarcomas in 13 patients (with an average age of 9.6 years) between 2017 and 2023. Reconstructions were proximal femur (n = 6), intercalary femur (n = 4), intercalary tibia (n = 2), and proximal humerus (n = 1) tumor prostheses. The hollow body was used distally in 10 of the megaprotheses, proximally in 1, and both proximally and distally in 2 of them. The average distance from the joints was 6 cm in stems with flanches and 11.8 cm in stems without flanches. No aseptic loosening or deep infection was observed during an average follow-up of 34 months. Except for one case with a tibial intercalary prosthesis that needed a revision, all cases were well osteointegrated and all lower extremity cases could bear full weight without pain. In cases where the remaining bone stock after bone resection is insufficient for a standard stem implantation, reconstruction with a patient-specific short hollow-stem design appears to be a good alternative to protect healthy joints with high prosthesis survival and low revision rates in the short-term follow-up. Full article

Purpose: This study aimed to identify the demographic-, radiographic-, and surgery-related factors influencing postoperative functional internal rotation (fIR) following reverse total shoulder arthroplasty (RTSA). Methods: In this retrospective cohort study, patients who underwent RTSA between June 2013 and April 2018 at a single institution were assigned to two groups (“IROgood” or “IRObad”). Patients were classified as having good fIR (≥8 points in the Constant–Murley score (CS) and fIR to the twelfth thoracic vertebra or higher) or poor fIR (≤2 points in the CS and fIR to the twelfth thoracic vertebra or lower) after RTSA with a single implant model. The minimum follow-up period was two years. Standardized shoulder-specific scores (Visual Analogue Scale (VAS), Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons Score (ASES), Constant–Murley score (CS)) were used to assess the pre- and postoperative functional status of patients. Postoperative radiographic evaluation included the distalization shoulder angle (DSA), lateralization shoulder angle (LSA), critical shoulder angle (CSA), acromiohumeral distance (AHD), glenoid inclination (GI), medialization of the center of rotation (COR), lateralization of the humerus, and distalization of the greater tuberosity. Additionally, preoperative evaluation included rotator cuff arthropathy according to Hamada, glenoid version, anterior or posterior humeral head subluxation, and fatty infiltration of the rotator cuff according to Goutallier. Univariate analysis of demographic, surgical, radiographic, and implant-associated parameters was performed to identify factors associated with postoperative fIR. The Shapiro–Wilk test assessed the normal distribution of the data. Intergroup comparisons regarding demographic and surgery-related factors were conducted using the Mann–Whitney-U Test. Radiographic changes were compared using chi-square or Fisher’s exact tests. The significance level was set at p < 0.05. Results: Of a total of 42 patients, 17 (age: 73.7 ± 5.0 years, follow-up (FU) 38 months [IQR 29.5–57.5]) were included in the “IRObad” group, and 25 (age: 72 ± 6.1 years, FU 47 months [IQR 30.5–65.5]) were included in the “IROgood” group. All patients were treated with the same type of implant (glenosphere size: 36 mm, 14.3%; 39 mm, 38.1%; 42 mm, 47.6%; neck-shaft angle: 135° in 68.0%; 155° in 32.0%) and had comparable indications. Univariate analysis did not reveal any of the investigated demographic, radiographic, or surgery-related parameters as risk factors for poor postoperative fIR (p > 0.05). Conclusion: None of the investigated factors, including implant-associated parameters, influenced postoperative fIR after RTSA in this cohort. Full article

The paleopathological literature notably lacks the description and analysis of distal humeral fractures and their associated complications. The objectives of this study were (1) to evaluate a distal humerus fracture associated with cubitus valgus observed in the articulated right elbow of an adult male buried in the Santa Caterina Friary site in Barcelona, dating back to the modern period (15th to early 16th century), and (2) to contribute to the valorization of bioarcheological heritage. Employing macroscopic and radiographic studies, the injury was assessed. The results indicated a healed antemortem fracture, probably associated with a fall. In the AO/OTA classification, it corresponds to type 13C1.1 (complete articular fracture, articular simple, metaphyseal simple, above the transcondylar axis), accompanied by a coronoid process fracture due to anterior trochlear dislocation impact (O’Driscoll type 1 classification: transverse fracture of the distal apophysis with involvement of the sublime tubercle). This fracture, resulting in a 28° cubitus valgus and significant elbow changes, infers community support in healing and highlights the socio-economic dynamics of guilds and adaptive strategies to physical adversities. This study is one of the first to describe cubitus valgus in a historical Spanish population, offering a comprehensive view of the complexities, physical adversities, and adaptive strategies employed by individuals following an elbow fracture. Full article

Background: Chondroblastoma (CB), a rare benign bone tumor that produces chondrocytes, often develops in the epiphysis or apophysis of children and young adults. The treatment of these rare tumors is complex. The standard treatment protocol involves curettage with local adjuvants and bone graft or cement application. The authors examined 38 CBs to determine risk factors for local recurrence, complications, and functional outcomes following epiphyseal curettage. Methods: Twenty-two girls and sixteen boys aged 10 to 17 years with histologically confirmed chondroblastoma who arrived at our hospital between January 2000 and June 2021 were reviewed retrospectively. Clinical data, radiographic images, histological results, treatment, functional outcomes, and the local recurrence rate were examined—surgical treatment involved total tumor curettage, followed by bone grafting and adjuvant techniques. Local recurrences have also been reported. Results: The most frequently affected site was the proximal femur. Sites of involvement included the proximal femur in 10 (26.3%) cases, the proximal tibia in 8 (20.8%), the humerus in 5 cases (13.2%), the distal tibia in 4 cases (10.5%), the distal femur in 3 cases (7.9%), the supracetabular region in 3 cases (7.9%), the talus in 1 case (2.6%), the calcaneus in 1 case (2.6%), the scapula in 1 case (2.6%), the lumbar spine in 1 case (2.6%), and the iliac bone in 1 (2.6%) patient. The mean follow-up was 144.2 months (24 to 276). The local recurrence rate was 7.9%. The mean Musculoskeletal Tumor Society (MSTS) score was 28.3 points (17 to 30). The mean duration of symptoms at presentation was 5.8 (range, 1 to 28) months. Conclusion: Aggressive curettage and bone grafting resulted in local control and good outcomes in most pediatric patients. In a relatively small proportion of cases, long-term complications and recurrence can occur due to growth plate damage and late diagnosis. In patients admitted to the pediatric clinic with pain, which is often accompanied by localized edema and joint effusion, early detection via advanced radiological scans (X-ray, CT, or MRI) may prevent delays in diagnosis. Full article

Background: Fractures through the physis account for 18–30% of all paediatric fractures, leading to growth arrest in up to 5.5% of cases. We have limited knowledge to predict which physeal fractures result in growth arrest and subsequent deformity or limb length discrepancy. The purpose of this study is to identify factors associated with physeal growth arrest to improve patient outcomes. Methods: This prospective cohort study was designed to develop a clinical prediction model for growth arrest after physeal injury. Patients ≤ 18 years old presenting within four weeks of injury were enrolled if they had open physes and sustained a physeal fracture of the humerus, radius, ulna, femur, tibia or fibula. Patients with prior history of same-site fracture or a condition known to alter bone growth or healing were excluded. Demographic data, potential prognostic indicators, and radiographic data were collected at baseline, during healing, and at one- and two-years post-injury. Results: A total of 332 patients had at least six months of follow-up or a diagnosis of growth arrest within six months of injury. In a comparison analysis, patients who developed growth arrest were more likely to be older (12.8 years vs. 9.4 years) and injured on the right side (53.0% vs. 45.7%). Initial displacement and angulation rates were higher in the growth arrest group (59.0% vs. 47.8% and 47.0% vs. 38.8%, respectively), but the amount of angulation was similar (27.0° vs. 28.4°). Rates of growth arrest were highest in distal femoral fractures (86%). Conclusions: The incidence of growth arrest in this patient population appears higher than the past literature reports at 30.1%. However, there may be variances in diagnostic criteria for growth arrest, and the true incidence may be lower. A number of patients were approaching skeletal maturity, and any growth arrest is likely to have less clinical significance in these cases. Further prospective long-term follow-up is required to determine risk factors, incidence, and true clinical impact of growth arrest when it does occur. Full article

Background: Multi-comminuted, intra-articular fractures of the distal humerus still pose a challenge to modern orthopedics due to unsatisfactory treatment results and a high percentage (over 50%) of postoperative complications. When surgical treatment is chosen, such fractures are fixed using two plates with locking screws, which can be used in three spatial configurations: either parallel or one of two perpendicular variants (posterolateral and posteromedial). The evaluation of the fracture healing conditions for these plate configurations is unambiguous. The contradictions between the conclusions of biomechanical studies and clinical observations were the motivation to undertake a more in-depth biomechanical analysis aiming to indicate the weak points of two-plate fracture stabilization. Methods: Research was conducted using the finite element method based on an experimentally validated model. Three variants of distal humerus fracture (Y, λ, and H) were fixed using three different plate configurations (parallel, posterolateral, and posteromedial), and they were analyzed under six loading conditions, covering the whole range of flexion in the elbow joint (0–145°). A joint reaction force equal to 150 N was assumed, which corresponds with holding a weight of 1 kg in the hand. The biomechanical conditions of bone union were assessed based on the interfragmentary movement (IFM) and using criteria formulated by Steiner et al. Results: The IFMs were established for particular regions of all of the analyzed types of fracture, with distinction to the normal and tangential components. In general, the tangential component of IFM was greater than normal. A strong influence of the elbow joint’s angular position on the IFM was observed, with excessive values occurring for flexion angles greater than 90°. In most cases, the smallest IFM values were obtained for the parallel plaiting, while the greatest values were obtained for the posteromedial plating. Based on IFM values, fracture healing conditions in particular cases (fracture type, plate configuration, loading condition, and fracture gap localization) were classified into one of four groups: optimal bone union (OPT), probable union (PU), probable non-union (PNU), and non-union (NU). Conclusions: No plating configuration is able to ensure distal humerus fracture union when the full elbow flexion is allowed while holding a weight of 1 kg in the hand. However, flexion in the range of 0–90° with such loadings is acceptable when using parallel plating, which is a positive finding in the context of the early rehabilitation process. In general, parallel plating ensures better conditions for fracture healing than perpendicular plate configurations, especially the posteromedial version. Full article

After artificial joint surgery, bone density may decrease around the artificial joint; thus, postoperative bone density evaluation around the artificial joint is crucial. We investigated changes in bone mineral density and performed radiographic evaluation around the stem after reverse shoulder arthroplasty (RSA) surgery in 17 males (18 shoulders) and 19 females (19 shoulders), aged >65 years, with >1-year follow-up. In total, 20 and 17 cases involved massive rotator cuff tears and rotator cuff tear arthropathy, respectively. The Comprehensive Reverse Shoulder System (Standard Ingrowth) was used for all cases and cement was used in eight patients due to bone fragility. We examined lucent lines, loosening, bone resorption, and spot welds in non-cemented cases using plain radiography and postoperative bone density changes around the stem using dual-energy X-ray absorptiometry (DEXA). Lucent lines and bone resorption occurred in 5 (13.5%) and 19 (51.4%) shoulders, respectively. No loosening occurred. Compared to stem bone density at 2 weeks postoperatively, the decrease rate was the largest in the proximal medial humerus. One-year postoperative bone density was not related to sex, age, cement use, or preoperative diagnosis. Higher preoperative bone density was better maintained postoperatively. Furthermore, 1 year post RSA, spot welds were observed in approximately 48.2% of cases at the distal medial portion of the stem coating, and bone resorption occurred in the proximal medial humerus in 43.2% of cases. Therefore, postoperative bone density is related to preoperative bone density, suggesting the importance of maintaining high preoperative bone density. Full article