Application of 3D printing-designed split-piece sleeve prosthesis in the revision surgery of tumor-type total elbow prosthetic fractures: a case report

Abstract

Objective This study aimed to assess the application of split sleeve technology in the revision surgery of tumor-type total elbow prosthetic fractures. Case report This retrospective study included a 57-year-old female patient who suffered from left upper arm pain and limited activity for half a month due to trauma. She was admitted to the 960th Hospital of the People’s Liberation Army (Jinan, China) on October 14, 2016. The histopathological type of tumor was hemangioma with active chondroblast proliferation. Following the diagnosis of a bone tumor in the left distal humerus, along with a pathological fracture, customized tumor-type total elbow prosthetic replacement was carried out due to extensive bone destruction in the affected area. After 5 years, she developed left elbow pain and difficulty in flexing the elbow when lifting heavy objects. X-ray showed that the lateral parts of the connection between the left distal humerus and the ulnar prosthesis were displaced. The patient was admitted to the hospital with the diagnosis of prosthetic fracture. Given the absence of bone cement stem loosening in the humeral and ulnar bone marrow, as well as the absence of fractures or osteolysis around the prosthesis, opting for a complete prosthesis revision would result in more substantial bone damage. Hence, the decision was made to retain the original prosthesis. With the assistance of three-dimensional (3D) printing technology, a split-piece sleeve prosthesis at the broken end hinge was designed, and the left distal humeral prosthesis was subsequently revised with a split-piece sleeve total elbow prosthesis at the broken end. Outcome and Follow-up The surgical process went smoothly, and the prosthesis was accurately installed according to the preoperative design. The patient recovered well after the surgery and the incision was healed in the first stage. During the 2 year follow-up, the elbow split socket prosthesis was firmly fixed without loosening. At the last follow-up, the Mayo Elbow Performance Score (MEPS) was 80 points, and the range of motion of the elbow was 25°～110°. Conclusion The split sleeve technique possesses the advantages of low surgical difficulty, limited trauma, and definite clinical efficacy in the revision surgery of tumor-type total elbow prosthetic fractures.