Distal Humeral Fixation of an Intramedullary Nail Periprosthetic Fracture

Abstract

Distal humeral periprosthetic fractures below intramedullary nail devices are complex and challenging to treat, in particular due to the osteopenic/porotic nature of bone found in these patients. Fixation is often difficult to satisfactorily achieve around the intramedullary device, whilst minimising soft tissue disruption. Descriptions of such cases in the current literature are very rare. We present the case of a midshaft humeral fracture treated with a locking compression plate that developed a nonunion, in a 60-year old female. This went on to successful union after exchange for an intramedullary humeral nail. Unfortunately, the patient developed a distal 1/5th humeral periprosthetic fracture, which was then successfully addressed with a single-contoured, extra-articular, distal humeral locking compression plate (Synthes) with unicortical locking screws and cerclage cables proximally around the distal nail tip region. An excellent postoperative range of motion was achieved.

Locking compression plate fixation of periprosthetic distant humeral fracture after intramedullary nail for humeral shaft fracture: A case report

“…Periprosthetic distant humeral fracture after intramedullary nail for humeral shaft fracture is relatively rare in clinical practice. Only a few cases have been reported in literature [1] , [2] , [3] .…”

Traumatic periimplant fracture after nail arthrodesis of the knee in a limb reconstruction case

“…The method of choice after periimplant fractures treated with intramedullary nailing appears to be to exchange of the initially implanted nail to a longer device, which was performed in the majority of the published cases [[4], [5], [6]]. However, in some cases with articular fractures plating had been necessary [2]. To our opinion, intramedullary nailing accomplishes the goals of s stabilizing a periimplant fracture after intramedullary knee arthrodesis, maintaining length and rotation as well as saving the bone regenerate according to the nailing after lengthening principles in this specific case.…”

“…Periimplant fractures after knee arthrodesis nails are very rare [1] and challenging to treat [2]. Especially high energy trauma is the main risks for these injuries in young patients [3] resulting in complex surgeries [4].…”

“…Exchange of the knee arthrodesis nail to a longer one is the preferred method in most of the published cases [[4], [5], [6]]. However, in some cases (long nails, articular fractures) plating is necessary [2].…”

Knee Arthrodesis in Severe Injured Knee Joints

“…Arthrodesis nail breakage or periprosthetic fractures [16] are most uncommon [17,18]. However, these complications need meticulous treatment either by implantation of a longer nail [7] or even plating [19], depending on the location of fracture and the treated bone. Hinarejos et al [18] reported periprosthetic fractures above and below a modular knee arthrodesis nail.…”