Revision trauma: case of fresh peri implant stress fracture in an operated distal humerus with nonunion of older fracture
Here is presented a case of an
old man who had sudden onset pain and abnormal mobility in his left arm while
getting up from chair with support from his left hand. The patient had history
of fracture in this arm one year back which was operated outside. The left had
a healed scar spanning almost the entire distal 2/3rd of the arm
dorsally. X rays showed nonunion distal metaphyseal humerus with 2 plates in
situ. A fresh fracture had taken place at the end of the two plate’s most
likely due to stress on bone due to the implant. Some of the screws were also
broken suggestive of stress on implant also. The patient was taken to operation
theatres. All metal ware was removed. Broken screws were retrieved with hollow
mill. The nonunion site was freshened, exposed and reduced. However varus at
nonunion site could not be corrected fully due to very tight soft tissues and
loss of bone on medial side of humerus. The fracture and nonunion were fixed
with 2 locking plates. Both the sites were grafted using cancellous bone from
iliac crest. We had a tight closure over drain. Post operatively the limb was
elevated and ice compression was done. After three days, by the time of first
dressing, swelling had markedly decreased.