Interprosthetic humeral fracture revision using a tibial allograft total elbow prosthetic composite in a patient with hemophilia A : a case report

Abstract

IntroductionInterprosthetic fractures of the humerus are rare. Revisions of total elbow arthroplasty components in these cases are difficult. We report the first case of a patient with hemophilia who underwent a revision with a tibial allograft prosthetic composite without the need for hardware augmentation.Case presentationA 43-year-old Caucasian man with a history of hemophilia and transfusion-related human immunodeficiency virus and hepatitis B and C presented with an interprosthetic fracture of his humerus after months of pain between his total elbow and total shoulder arthroplasties. Because of the poor remaining bone stock available in his distal humerus, a revision using a barrel-staved tibial allograft prosthetic composite was performed. Our patients’ factor VIII level was optimized before the operation and he suffered no major long-term complications at 28 months. His only complication was an incomplete radial nerve palsy that ultimately recovered and left him with some numbness on the dorsum of his hand.ConclusionCareful use of an allograft prosthetic composite is a very reasonable option when a patient experiences an interprosthetic fracture. We have successfully performed revision total elbow arthroplasty for a patient with hemophilia with an interprosthetic fracture using a tibial allograft and no additional fixation, which resulted in his return to full activities of daily living, minimal pain and full incorporation of the allograft to host bone.

A Novel Approach to Treat a Rare Case of Interprosthetic Humeral Fracture with Osteosynthesis and Combined Grafting: A Case Report and Review of the Literature

“…Only eight papers discussing the management and treatment of IHFs [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ] were found through the literature review and were included in our article. A biomechanical study with a finite element analysis was also included in our review [ 16 ].…”

“…All other authors preferred surgical management. A posterior approach was used in most of the cases, utilising the tricep splitting method [ 8 , 9 , 13 , 14 ] or the tricep sparing technique [ 11 ]. The most popular choice was the use of an LCP (locking compression plate) with allograft, aided by cerclage and cables.…”

“…Carroll et al [ 8 ] described a technique with a 90–90 double plating in the distal humerus, used in order to enhance the stability of poor bone quality. LeBlanc et al [ 11 ] described a novel approach with allograft prosthetic composite (APC) with tibia allograft without hardware augmentation in a severe haemophiliac patient, with good final results. The procedure led to allograft integration and a satisfactory range of motion, although the patient was found to have postoperative partially radial nerve palsy, presumably due to the bleeding caused by surgical traction in the haemophiliac patient.…”

“…They allow for a quicker and more solid fracture healing process. Allograft substitutes are the most commonly used for the treatment of such injuries [ 9 , 10 , 11 , 14 ].…”

Fungal periprosthetic joint infection following total elbow arthroplasty: a case report and review of the literature

“…Reimplantation surgery was undertaken using a similar method reported by LeBlanc et al . 2012 [4]; an allograft-prosthetic composite was used consisting of a long-stemmed cemented Coonrad-Morrey TEA (Zimmer) and tibial allograft on the humeral side (Fig. 2).…”