Periprosthetic Fracture after Proximal Humeral Intramedullary Nail, Treated by Functional Bracing - A Case Report -

Jae-Hyuk Shin; Ho-Guen Chang; Young-Woo Kim; Nam-Kyou Rhee; Yong-Bok Park; Yong-Kuk Kim

doi:10.12671/jkfs.2011.24.2.185

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Shin, Chang, Kim, Rhee, Park, and Kim: Periprosthetic Fracture after Proximal Humeral Intramedullary Nail, Treated by Functional Bracing - A Case Report -

Case Report

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2011; 24(2): 185-190.

Published online: 13 April 2011

DOI: https://doi.org/10.12671/jkfs.2011.24.2.185

Periprosthetic Fracture after Proximal Humeral Intramedullary Nail, Treated by Functional Bracing - A Case Report -

Jae-Hyuk Shin, M.D., Ho-Guen Chang, M.D., Young-Woo Kim, M.D., Nam-Kyou Rhee, M.D.^*, Yong-Bok Park, M.D., Yong-Kuk Kim, M.D.

Department of Orthopedic Surgery, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea.

^*Department of Orthopedic Surgery, Shin Hospital, Suwon, Korea.

Address reprint requests to: Ho-Guen Chang, M.D. Department of Orthopedic Surgery, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, 94-200, Yeongdeungpo-dong, Yeongdeungpo-gu, Seoul 150-037, Korea. Tel: 82-2-2639-5650, Fax: 82-2-2639-5654, hgchang@hallym.or.kr

Received 29 August 2010 Revised 16 November 2010 Accepted 21 December 2010

(open-access):

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

Abstract

Periprosthetic fracture following a proximal humeral intramedullary (IM) nailing is rarely reported neither for its occurrence nor for its treatment. Proximal humeral IM nail (Acumed, LLC, Hillsboro, OR, USA) has been increasingly reported of its successful treatment outcomes, yet there is paucity of data describing its complications. Here we report a 26 year-old female patient, who sustained a proximal humerus fracture which was initially successfully treated by proximal humeral IM nail, and was complicated by a periprosthetic fracture distal to the nail tip at postoperative 4 months. Serial application of U-shaped coaptation splint, hanging cast, and functional bracing resulted in satisfactory clinical outcome. Periprosthetic fracture after proximal humerus IM nail can occur by a low energy injury, which need to reminded in treating young and sports-active patients.

Keywords: Proximal humerus fracture, Periprosthetic fracture, Proximal humeral IM nail

Figures and Tables

Fig. 1

Initial radiographs of a 26-year-old woman shows proximal humerus three-part comminuted fracture, involving the metaphysis.

(A) Scapular lateral view.

(B) Humerus antero-posterior view, and (C) Shoulder Axial view.

Fig. 2

Postoperative radiographs show internal fixation of the proximal humerus fracture using the Polarus IM nail (Acumed). The nail head was sunk beneath the humeral head in order to avoid subacromial impingement.

(A) Antero-posterior view, and (B) Lateral view.

Fig. 3

Periprosthetic fracture developed 4 months after the IM nailing. The fracture developed at 2 cm distal to the IM nail tip, spirally advancing distantly toward the metaphysis. Radiographs suggested union of the previously sustained proximal humerus fracture, and stable fixation of the IM nail.

Fig. 4

The IM nail was removed and U-shaped coaptation splint was applied following careful reduction. The previous proximal fracture manifested callus formation and uneventful fracture healing.

Fig. 5

(A) At 12 days after periprosthetic fracture hanging cast is applied.

(B) Initial hanging cast presents posterior angulation and varus angulation of the fracture site.

(C) The strap was lengthened and advanced toward volar aspect of the wrist to correct the posterior angulation and the varus angulation.

Fig. 6

At 3 weeks after periprosthetic fracture functional brace and arm sling were applied.

(A) The fracture angulation and alignment were tolerable.

(B) The elbow motion was gently allowed to prevent stiffness.

Fig. 7

By 40 days after periprosthetic fracture the patient presented ROM recovery both in the (A) shoulder joint, and in the (B) elbow joint.

(C) Radiographs show good alignment and callus formation suggesting successful union process.

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