Operative treatment is associated with improved 3-year survival after periprosthetic humerus fracture.

Background: This study examines the survival implications of operative versus nonoperative management of periprosthetic humerus fractures in a large, single-center cohort. Methods: Patients at a single tertiary care center with periprosthetic humerus fractures about a shoulder prosthesis between January 2013 and March 2024 were retrospectively identified. Patients were stratified according to operative versus nonoperative treatment. The primary outcome was all-cause mortality. Survival was compared using Kaplan-Meier curves and log-rank tests. Prespecified time horizons were 90 days, 1 year, 2 years, and 3 years. Results: Ninety patients with periprosthetic fractures were identified (23 nonoperative, 67 operative). There were 13 total deaths (8/23 [35%] nonoperative, 5/67 [7.5%] operative). Baseline characteristics were largely similar aside from a higher body mass index in the operative group (32 vs. 29 kg/m Conclusions: Surgical fixation of periprosthetic humerus fractures is associated with lower mortality that becomes apparent in a delayed fashion and grows over time. By 3 years after the injury, the mortality difference approached 25% between operatively and nonoperatively treated patients. These findings should be validated in larger, multicenter studies.