Bilateral Reverse Total Shoulder Arthroplasty for Bilateral Proximal Humeral Fractures Complicated by Periprosthetic Fractures

Reverse shoulder arthroplasty (RSA) is being increasingly employed for complex proximal humeral fractures (PHFs) in older patients, particularly in cases with severe osteoporosis. However, bilateral PHFs and subsequent periprosthetic fractures remain rare and challenging. We report a case of a 60-year-old woman with alcoholic liver disease who sustained bilateral PHFs after a fall. Due to her compromised condition, staged bilateral RSA was performed. The initial postoperative course was uneventful. Eight months after the first surgery, she sustained a displaced periprosthetic fracture on the right, which required revision RSA with a cemented long-stem prosthesis. Two months later, a minimally displaced fracture occurred on the left, accompanied by radiographic loosening. Conservative management with teriparatide achieved successful bone union. At final follow-up, shoulder function declined on the revised side but was preserved on the conservatively managed side. These findings suggest that conservative management may be a viable option when fracture displacement is limited and pain is tolerable. Moreover, early pharmacologic intervention and attention to implant technique may reduce the risk of periprosthetic complications. This case highlights the importance of individualized treatment planning for periprosthetic fractures following RSA and supports the potential role of teriparatide in promoting fracture healing.