Abstract
IntroductionInterprosthetic fractures of the humerus are rare. Revisions of total elbow arthroplasty components in these cases are difficult. We report the first case of a patient with hemophilia who underwent a revision with a tibial allograft prosthetic composite without the need for hardware augmentation.Case presentationA 43-year-old Caucasian man with a history of hemophilia and transfusion-related human immunodeficiency virus and hepatitis B and C presented with an interprosthetic fracture of his humerus after months of pain between his total elbow and total shoulder arthroplasties. Because of the poor remaining bone stock available in his distal humerus, a revision using a barrel-staved tibial allograft prosthetic composite was performed. Our patients’ factor VIII level was optimized before the operation and he suffered no major long-term complications at 28 months. His only complication was an incomplete radial nerve palsy that ultimately recovered and left him with some numbness on the dorsum of his hand.ConclusionCareful use of an allograft prosthetic composite is a very reasonable option when a patient experiences an interprosthetic fracture. We have successfully performed revision total elbow arthroplasty for a patient with hemophilia with an interprosthetic fracture using a tibial allograft and no additional fixation, which resulted in his return to full activities of daily living, minimal pain and full incorporation of the allograft to host bone.
Highlights
Interprosthetic fractures of the humerus are rare
We have successfully performed revision total elbow arthroplasty for a patient with hemophilia with an interprosthetic fracture using a tibial allograft and no additional fixation, which resulted in his return to full activities of daily living, minimal pain and full incorporation of the allograft to host bone
Arthroplasty is common in patients with hemophilia, secondary to repeat bleeding into joints that causes joint arthropathy
Summary
To the best of our knowledge, this is the first report of the use of a tibial APC without hardware for an interprosthetic humerus fracture. Careful use of the APC with gross bone loss is a very reasonable option when a patient has an interprosthetic fracture. We found that revision TEA in a patient with hemophilia with an interprosthetic fracture using a tibial allograft and no additional fixation resulted in a return to full ADL, minimal pain and full incorporation of the allograft to the host bone. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Authors’ contributions JL reviewed the available literature, and drafted the manuscript. SP and KH assisted with providing in-depth background knowledge of the patient and procedure as well as a critical review of the manuscript.
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