J Korean Fract Soc.  2011 Apr;24(2):185-190. 10.12671/jkfs.2011.24.2.185.

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

• Shin JH
• Chang HG
• Kim YW
• Rhee NK
• Park YB
• Kim YK

• KMID: 2183863
• DOI: http://doi.org/10.12671/jkfs.2011.24.2.185

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.

Keyword

Proximal humerus fracture; Periprosthetic fracture; Proximal humeral IM nail

MeSH Terms

Braces
Female
Humans
Humerus
Nails
Periprosthetic Fractures
Splints

Figure

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  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.

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  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.

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  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.

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  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.

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  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.

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  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.

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  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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