The “Docking” Method for Periprosthetic Humeral Fracture After Total Elbow Arthroplasty

Treatment of a humeral shaft fracture following total elbow arthroplasty is a challenging problem, especially in the presence of a large bone defect and osteoporosis1-5. Periprosthetic humeral fractures usually require surgical repair. This can involve revision of the humeral component, fixation of the fracture with a plate or cerclage wires, use of a strut allograft, or revision with use of an allograft-prosthesis composite1. We used a customized intramedullary nail and supplemental autologous cancellous bone graft to treat a periprosthetic humeral fracture in a woman with rheumatoid arthritis who had a massive bone defect and poor bone quality. The patient was informed that data concerning the case would be submitted for publication, and she consented. A fifty-three-year-old woman presented with pain and deformity of the left elbow. She had rheumatoid arthritis and had been treated with oral prednisolone and methotrexate for more than fifteen years. The range of flexion of the elbow was from 30° to 90°. Radiographic findings were compatible with severe rheumatoid arthritis. Because the pain, deformity, and instability were intolerable to the patient, total elbow arthroplasty was carried out with a Gschwend-Scheier-Bahler (GSB)-III prosthesis (Zimmer, Warsaw, Indiana). Postoperatively, the wound did not heal, and, after four weeks, Enterobacter cloacae was grown on culture of specimens from a fistula. The infection was controlled, without removing the implant, by debridement, continuous irrigation, coverage of the fistula with an anconeus muscle flap, and administration of culture-specific intravenous antibiotics. After one year without additional problems, the patient fell and sustained a fracture of the humerus just proximal to …