Interprosthetic humeral fractures (IHFs) are severe injury patterns associated with surgical issues and contradictory results. The knowledge and literature on this topic are still lacking. A 76 year-old woman was treated for a fracture occurred between the shoulder and elbow stemmed prosthesis. Severe bone loss was associated with the fracture. Treatment: Open reduction, plate fixation, and bone grafting were considered. A xenograft (used as a mechanical strut medially), a synthetic graft associated with bone growth factors, and scaffolds improved the bone healing process. Satisfactory clinical and radiological outcomes were obtained. A scoping review of the literature was also performed by the authors. Only eight papers reported IHFs with a low level of evidence. In total, eight patients were treated; one paper that reported on biomechanical aspects using finite element analysis is discussed. Conservative treatment leads to non-union, and the surgical approach is the gold standard. The osteosynthesis technique associated with bone grafting leads to the best outcomes. The use of a xenograft mechanical strut, associated with synthetic biological bone grafting, led to complete bone union at 9 months follow-up. Larger cohorts, more standardised results, and multicentric studies are mandatory in order to improve and establish a management and treatment algorithm.

A Novel Approach to Treat a Rare Case of Interprosthetic Humeral Fracture with Osteosynthesis and Combined Grafting: A Case Report and Review of the Literature

Caraffa A.;
2022

Abstract

Interprosthetic humeral fractures (IHFs) are severe injury patterns associated with surgical issues and contradictory results. The knowledge and literature on this topic are still lacking. A 76 year-old woman was treated for a fracture occurred between the shoulder and elbow stemmed prosthesis. Severe bone loss was associated with the fracture. Treatment: Open reduction, plate fixation, and bone grafting were considered. A xenograft (used as a mechanical strut medially), a synthetic graft associated with bone growth factors, and scaffolds improved the bone healing process. Satisfactory clinical and radiological outcomes were obtained. A scoping review of the literature was also performed by the authors. Only eight papers reported IHFs with a low level of evidence. In total, eight patients were treated; one paper that reported on biomechanical aspects using finite element analysis is discussed. Conservative treatment leads to non-union, and the surgical approach is the gold standard. The osteosynthesis technique associated with bone grafting leads to the best outcomes. The use of a xenograft mechanical strut, associated with synthetic biological bone grafting, led to complete bone union at 9 months follow-up. Larger cohorts, more standardised results, and multicentric studies are mandatory in order to improve and establish a management and treatment algorithm.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11391/1545753
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