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Review Article Treatment of Periprosthetic Fracture after Total Elbow Replacement Arthroplasty
Hyunseok Seo, Jin-Hyung Im, Joo-Yup Lee
Journal of Musculoskeletal Trauma 2020;33(2):110-117.
DOI: https://doi.org/10.12671/jkfs.2020.33.2.110
Published online: April 30, 2020
1Department of Orthopedic Surgery, The Catholic University of Korea, Eunpyeong St. Mary’s Hospital, Seoul, Korea
2Department of Orthopedic Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea

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Abstract

The indications for total elbow replacement arthroplasty (TERA) include rheumatoid arthritis, degenerative arthritis, acute fracture, nonunion, malunion, posttraumatic arthritis, tumor, and chronic instability. With the development of designs and the increasing use of TERA, more periprosthetic fractures are occurring. On the other hand, there is less data on periprosthetic fractures after TERA because TERA is a relatively rare procedure. Thus, a careful review of the previous literature and appropriate selection of surgical indications are essential for achieving a satisfactory outcome, which should be accompanied by precise surgery as planned. This article presents the causes, risk factors, classification, and principles of treatment of periprosthetic fractures after TERA.


J Korean Fract Soc. 2020 Apr;33(2):110-117. Korean.
Published online Apr 28, 2020.
https://doi.org/10.12671/jkfs.2020.33.2.110
Copyright © 2020 The Korean Fracture Society. All rights reserved.
Review

Treatment of Periprosthetic Fracture after Total Elbow Replacement Arthroplasty

Hyunseok Seo, M.D., Jin-Hyung Im, M.D., Ph.D.,* and Joo-Yup Lee, M.D., Ph.D.
    • Department of Orthopedic Surgery, The Catholic University of Korea, Eunpyeong St. Mary's Hospital, Seoul, Korea.
    • *Department of Orthopedic Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea.
  • Correspondence to: Joo-Yup Lee, M.D., Ph.D. Department of Orthopedic Surgery, The Catholic University of Korea, Eunpyeong St. Mary's Hospital, 1021 Tongil-ro, Eunpyeong-gu, Seoul 03312, Korea. Tel: +82-2-2030-4432, Fax: +82-2-2030-4269, Email: jylos1@gmail.com
Received March 20, 2020; Revised March 27, 2020; Accepted March 27, 2020.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The indications for total elbow replacement arthroplasty (TERA) include rheumatoid arthritis, degenerative arthritis, acute fracture, nonunion, malunion, posttraumatic arthritis, tumor, and chronic instability. With the development of designs and the increasing use of TERA, more periprosthetic fractures are occurring. On the other hand, there is less data on periprosthetic fractures after TERA because TERA is a relatively rare procedure. Thus, a careful review of the previous literature and appropriate selection of surgical indications are essential for achieving a satisfactory outcome, which should be accompanied by precise surgery as planned. This article presents the causes, risk factors, classification, and principles of treatment of periprosthetic fractures after TERA.

Keywords
Elbow, Arthroplasty, Periprosthetic fracture

Figures

Fig. 1
Mayo classification of periprosthetic fractures after elbow arthroplasty. Type I, fracture of the humeral condyles and olecranon. Type II, humeral and ulnar shaft fracture along the length of the stem. Type III, fracture past the tip of the prosthesis.

Fig. 2
(A, B) Anteriorposterior (A) and lateral (B) elbow radiographs of a 41-year-old female with rheumatoid arthritis. The comminuted intra-articular fracture of the distal humerus with the displacement of the medial condyle was found. (C) Total elbow replacement arthroplasty was performed, and tension-band wiring was simultaneously applied simultaneously to fix the medial humeral condylar fracture. (D) Anteriorposterior radiographs of 3 months postoperatively, showing bony union.

Fig. 3
(A, B) Anteriorposterior (A) and lateral (B) elbow radiographs of the same patient in Fig. 2 shows the fracture line involved proximal and distal to the tip of the prosthesis with evidence of loosening. The fracture was caused by slip down at 3 years and 7 months after the primary total elbow replacement arthroplasty. (C, D) Revision arthroplasty was done with autologous iliac bone grafting and locking compression plate fixation. (E, F) Anteriorposterior (E) and lateral (F) radiographs of 6 months postoperatively, showing bony union.

Fig. 4
(A) Anteriorposterior and lateral elbow radiographs of a 67-year-old female who had internal fixation for the distal humeral intercondylar and olecranon fracture in the other hospital three-months ago. The radiographs showed no evidence of bony union at the distal humerus. (B) Removal of hardware and total elbow replacement arthroplasty were done. The long arm splint with elbow extension was applied anteriorly after the surgery. (C) Lateral elbow radiographs 1 month postoperatively, showing refracture of the previous olecranon osteotomy site. Conservative treatment with long arm splint was planned. (D) Lateral elbow radiographs of 2 months postoperatively, showing union of the fracture.

Tables

Table 1
Mayo Classification of Periprosthetic Fractures of the Elbow

Table 2
Grading Scale for Humeral Bone Loss

Notes

Financial support:None.

Conflict of interests:None.

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    Treatment of Periprosthetic Fracture after Total Elbow Replacement Arthroplasty
    J Korean Fract Soc. 2020;33(2):110-117.   Published online April 30, 2020
    DOI: https://doi.org/10.12671/jkfs.2020.33.2.110
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