Manohara R, Howie CR. Partial humeral replacement for peri-prosthetic fractures of the humerus.
J Clin Orthop Trauma 2017;
8:S62-S66. [PMID:
29158650 PMCID:
PMC5682877 DOI:
10.1016/j.jcot.2017.04.005]
[Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 04/04/2017] [Accepted: 04/27/2017] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION
Treating peri-prosthetic fractures of the humerus can be very challenging, especially when there is poor bone stock and in the presence of adjacent joint prostheses. We discuss the option of a partial humeral replacement as a salvage procedure for such cases with some technical comments.
METHODS
This paper presents a technique which utilises a custom- made cemented connector to incorporate the existing well functioning elbow or shoulder replacement with a commercially available partial humeral replacement (PHR) or to an existing prosthetic humeral stem.
RESULTS
Our series involves 6 patients with severe rheumatoid arthritis, all female, with a mean age of 62.5 years. Their surgeries were performed over a span of 10 years, with an average follow up of 49 months. All had a well functioning implant at final follow-up, with a mean Mayo Elbow Performance score of 65. There were no cases of infection, nerve injury or dislocation in our patients. There were 2 deaths in our series, from unrelated medical causes at 2 and 4 years following their surgery.
CONCLUSION
Although a partial humeral replacement connected to a well functioning implant is a rare procedure for salvage of a humeral peri-prosthetic fracture, it can be a viable option in certain patient populations. Every attempt should be made to maintain the secondary shoulder stabilisers at the proximal humerus as a functioning unit.
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