Management of Non-Prosthetic Peri-Implant Fracture in a Case of Broken Intramedullary Locking Nail - A Rare Case Report and Review of Literature

Jayesh Anant Mhatre,Nihar Modi,Amit Supe

doi:10.31579/2694-0248/024

Abstract

A non-prosthetic peri-implant fracture (NPPIF) can be defined as a fracture in a bone with an existing non-prosthetic implant such as an extramedullary plate and screws or an intramedullary nail, NPPIFs are mostly reported together with peri-prosthetic fractures (PPFs) that occur around joint replacement implants, but they represent a separate clinical entity with different conceptual and practical considerations1. Our case is a 72-year male with a broken humerus intramedullary Nail in right upper limb who was managed with implant removal and bridge plating with locking plate. The favourable outcome in our case sheds a light in a grey region of non-prosthetic peri implant fractures of upper limbs where no definite management protocol is available. Our patient had very good outcome which was noted by 0/100 on dash scores and complete pain-free range of movement elbow and shoulder. Our case stands as a manifest for NPPIFs of humerus, which can be managed with similar protocol which was used in our case.

Highlights

A non-prosthetic peri-implant fracture (NPPIF) can be defined as a fracture in a bone with an existing non-prosthetic implant such as an extramedullary plate and screws or an intramedullary nail
In our case the patient was operated with intramedullary humerus nail 20 years back, mostly are NPPIFs reported together with peri-prosthetic fractures (PPFs) that occur around joint replacement implants, but a separate clinical entity with different conceptual and practical considerations
Never- theless, the available bibliographical resources report that the general incidence of humeral shaft fractures remain in the area to 1% to 2% of all fractures occurring in the human body and 14% of all fractures of the humerus [2]

Summary

Introduction

A non-prosthetic peri-implant fracture (NPPIF) can be defined as a fracture in a bone with an existing non-prosthetic implant such as an extramedullary plate and screws or an intramedullary nail. On clinical examination there was swelling, tenderness and abnormal mobility along with crepitus over digital 1/3 of right upper arm He gave a history of operation over same injured limb 20 years back, no surgical details were available. Patient did not have distal neurovascular involvement or any other associated injuries and was relatively fit for surgery .He was posted for removal of the broken implant and fixation of fracture with open reduction internal fixation with the distal humerus pre-countered (LC-DCP) plate. Care was taken with the use of reduction clamps not to injure any of the neurovascular structures, which in the humerus may be close to the bone Alignment was confirmed, both visually and with the image intensifier, and the remainder of the screws were inserted. On follow up after 6 months of surgery patient had no lag in any range of movements of shoulder or elbow joint, his Distal Arm shoulder hand score was 0/100

Findings

Discussion

Conclusion