Treatment of Periprosthetic Humeral Shaft Fracture after Total Elbow Arthroplasty in an Osteoporotic Patient, using the Ilizarov External Ring Fixator: A Case Report.

Introduction: Periprosthetic humeral shaft fracture after total elbow arthroplasty (TEA) and open reduction and internal fixation at the same side humeral neck fracture in patients with osteoporosis poses a treatment challenge. Herein, we describe our experience with its treatment using the Ilizarov external ring fixator.

Case Report: A 74-year-old Japanese woman with rheumatoid arthritis and osteoporosis sustained a periprosthetic humeral shaft fracture. The fracture was externally fixated with the Ilizarov external ring fixator, and five wires (Orthofix, Lewisville, Texas) were inserted just beside the components of the TEA (three wires were beside the humeral component and two wires the ulnar component). 4 months postoperatively, the fracture showed bone union and the fixator was removed. There were minor pin tract infections treated with oral antibiotics and transient ulnar nerve palsy with resolution after 6 months of the fixator removal. During the period of wearing the fixator, the left elbow joint was immobilized, and mainly isometric muscle exercises were performed. At 6 months of follow-up after the fixator removal, the patient was pain free, with good functional results (patient-rated elbow evaluation Japanese version 8.6 and quick- disability of the arm, shoulder, and hand Japanese version 20.5), elbow range of motion 10-°, 80° pronation, and 80° supination. The patient returned successfully to her pre-injury occupational activities.

Conclusion: We believe that the use of the Ilizarov external fixator is a useful option for managing periprosthetic humeral shaft fractures after TEA in patients with osteoporosis.