Custom Reconstruction of the Distal Part of the Humerus Using Compressive Osseointegration: A Report of Three Cases.

Abstract

Reconstruction of the elbow with extensive humeral bone loss presents substantial challenges. Options include the use of allografts with standard elbow prostheses, modular devices, and custom implants1-4. Failure of allograft incorporation as well as implant failure can complicate attempts at such reconstruction. Prestressed osseointegration implants (Compress; Biomet, Warsaw, Indiana) have been successfully used to reconstruct massive segments of bone loss in the lower extremity5. To our knowledge, the use of such techniques in the upper extremity is limited to a single case report6. We describe three patients who underwent elbow arthroplasty for humeral reconstruction and who were managed with a Compress implant (Fig. 1). We received the approval of our Institutional Review Board for this case report. Fig. 1 This schematic shows the elements of the custom fabricated implants used in our three patients. The anchor plug is secured with five bicortical pins after bone preparation. The spindle, with its bone ingrowth surface, was inserted and tensioned. A force of 400 lb was chosen for all three implants, based on the manufacturer’s recommendation for a cortical thickness of 2.5 to 3.9 mm20. The humeral body and components of the distal part of the humerus were then sequentially impacted in place. A second humeral body component was used in Case 1 because of the extensive length that was required. Case 1. A sixty-five-year-old woman had incurred a comminuted fracture of the distal part of the humerus seven years prior to presentation. Previous treatment had included open reduction and internal fixation (ORIF) as well as subsequent total elbow arthroplasty (TEA) with triceps reconstruction (Table I). Two years after the TEA, the pain had returned. View this table: TABLE I History of Elbow Surgery and Year of Surgery On presentation to us, pain on the visual analog score (VAS) …