Distal humeral plating of an intramedullary nail periprosthetic fracture using a miss-a-nail technique: a case report

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Abstract

The treatment of distal humeral periprosthetic fractures is not widely described in the literature. We present a difficult clinical scenario of a 72-year-old man who sustained a displaced distal humeral periprosthetic fracture about a Polarus Plus intramedullary nail. In this case, stable fixation was achieved using bicondylar Acumed Mayo congruent Plates using a miss-a-nail technique. Four months following the post operative period, the patient regained satisfactory range of movement with full function and no further complications up to 18 months post fixation. Treatment of such complex periprosthetic fractures is technically achievable and with potentially good results.

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Most cited references 7

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Cephalomedullary interlocked nail for ipsilateral hip and femoral shaft fractures.

Ajay Agarwal, Ashish Upadhyay, Lalit Maini … (2004)

A retrospective study of the management of 23 cases of ipsilateral hip and femoral shaft fractures, between January 1998 and December 2001, is presented. All except two cases were managed by a single implant, i.e. reconstruction nail. There was delayed diagnosis of femoral neck fracture in two cases where the "miss a nail" technique was used for fixation of the femoral neck fracture. All patients managed by reconstruction nail were simultaneously operated on for both fractures and operative treatment was executed as early as the general condition of the patient permitted. Delay in treatment was generally because of the associated injuries (head, chest or abdominal). There were 22 males and 1 female patient with an average age of 34.5 years. Average follow-up was 30.9 months. There was one case of non-union of the femoral neck fracture, one case of avascular necrosis and one femoral neck fracture united in varus. There were four cases of non-union and six cases of delayed union of femoral shaft fractures. Mean time for union of the femoral neck fracture was 15 weeks and for the shaft fracture was 22 weeks. In this series femoral shaft fracture determined the total union period. Complications involving the femoral shaft fracture were more common than those related to femoral neck fractures. Shaft complications were more manageable with or without secondary procedures as compared to femoral neck complications, which usually require more extensive procedures. This stresses the need to realise the significance and seriousness of both components of this complex injury, in evaluation, management and post-operative care. We conclude that, though technically demanding, reconstruction nail is an acceptable alternative for management of concomitant fractures of the femoral neck and shaft with acceptable rates of complications and good results.

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Humeral fractures after shoulder arthroplasty.

Peter Wright, Robert Cofield (1995)

Nine humeral fractures occurred subsequent to 499 shoulder arthroplasties that had been performed between December 1978 and November 1987 at the Mayo Clinic. The time from the arthroplasty to the fracture averaged thirty-nine months (range, eight to 101 months). Seven patients were women and two were men, and the average age was seventy years (range, forty-five to eighty-five years). The arthroplasties were performed for rheumatoid arthritis in five patients and for the sequelae of trauma in four. Six patients had advanced osteopenia, and two had had an ipsilateral total elbow arthroplasty. Six of the fractures were centered at the tip of the prosthesis; one fracture (type A) extended proximally, and five (type B) did not. The three remaining fractures (type C) involved the humeral shaft distal to the implant and extended into the distal humeral metaphysis. Four fractures healed with non-operative treatment. Two fractures that had unacceptable alignment were treated successfully with operative intervention. Three fractures that were treated with immobilization in a splint failed to heal; two of those fractures eventually united after a revision of the prosthesis and bone-grafting was performed, and one fracture remained ununited. Radial nerve palsy developed postoperatively in two patients, and it resolved within three months. Five patients had poor active motion before the fracture, and two of them had even less motion after the fracture was treated. Our experience suggests that long oblique and spiral fractures can be successfully treated non-operatively, provided that the skeletal alignment is acceptable.(ABSTRACT TRUNCATED AT 250 WORDS)

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Periprosthetic humeral fractures: management and classification.

R Worland, D. Y. Kim, Juan Arredondo (2015)

Six patients (67 to 94 years of age) sustained a periprosthetic humeral fracture at an average of 43 months after shoulder arthroplasty (range 13 to 85 months). These fractures were classified depending on fracture anatomy and implant stability. Type A fractures occur about the tuberosities. Type B fractures occur about the stem and are subclassified by fracture anatomy and implant stability: B1 fractures are spiral fractures with a stable implant, B2 fractures are transverse or short oblique fractures about the tip of the stem with a stable implant, and B3 fractures are those fractures about the stem with an unstable implant. Type C fractures occur well distal to the tip of the stem. Five of the 6 fractures required surgery, 4 with revision to a long-stemmed component. All fractures united with restoration of range of motion and function. Satisfactory results may be anticipated if these fractures are managed in an appropriate fashion.

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Journal

Journal ID (nlm-ta): Cases J

Title: Cases Journal

Publisher: Cases Network Ltd

ISSN (Electronic): 1757-1626

Publication date (Electronic): 29 May 2009

Publication date Collection: 2009

Volume: 2

Electronic Location Identifier: 6704

Affiliations

[1 ]simpleDepartment of Orthopaedic Surgery, Guy's and St Thomas's Hospital LondonUK

[2 ]simpleDepartment of Orthopaedic Surgery, Darrent Valley Hospital Darftford, LondonUK

Article

Publisher ID: 6704

DOI: 10.1186/1757-1626-2-6704

PMC ID: 2740021

PubMed ID: 19829846

SO-VID: 18d67604-5347-403f-a53b-16c51ad5169f

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Distal humeral plating of an intramedullary nail periprosthetic fracture using a miss-a-nail technique: a case report

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Karger: Ophthalmology

Most cited references 7

Cephalomedullary interlocked nail for ipsilateral hip and femoral shaft fractures.

Humeral fractures after shoulder arthroplasty.

Periprosthetic humeral fractures: management and classification.

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