Mennen Plate Fixation For The Treatment Of Periprosthetic Fracture Of The Humeral Shaft: A Case Report

摘要

We report the case of a patient with a periprosthetic humeral fracture five months after Neer shoulder hemiarthroplasty was performed as a consequence of a four-part fracture of the proximal right humerus. The fracture had been initially treated with a plaster splint. However, two months later, no signs of bony union were present. For this reason the operative option was employed. In this sense, the Mennen plate was considered because of the difficulty in obtaining a proper fracture fixation with plate and screws or with plate and multiple cerclage wires or cables. The result obtained with this fixation system was satisfactory. Introduction Periprosthetic humeral fractures after shoulder arthroplasty represent a major complication and a challenging surgical problem. When this occurs various options have been proposed for the treatment of this potentially disabling condition, including conservative treatment with cast (9), revision arthroplasty using a longer stem (15), rigid internal fixation with cerclage wires (1), plate and screws (2), endomedular polymethylmethacrylate cement fixation (6) and Mennen plate fixation. In this later aspect, only two cases treated with this fixation system were reported in the literature (7). The purpose of this article is to report the third case of humeral fracture following shoulder hemiarthroplasty in which the Mennen plate was used with good result. Case Report A 71 year old female patient had an accidental fall for which a Neer shoulder hemiarthroplasty was performed as a consequence of a four-part fracture of the proximal right humerus. Five months later she fell down again and sustained a comminuted humeral peri-prosthetic fracture distal to the distal stem. The fracture had been initially treated with a plaster splint. However, two months later, no signs of bony union were present (Fig. 1). Because radiographs showed findings indicative of non-union, open reduction and internal fixation was performed. The humeral diaphysis was accessed through an anterolateral approach. The radial nerve was identified and protected. The non-union site was cleared of the soft tissues down to bleeding cortical bone. After proper reduction, the fracture was synthesized by means of a Mennen plate (CMW Laboratories, Exeter, England) and a cancellous bone graft, taken from the anterior iliac crest, was placed around the non-union site (Fig. 2). Postoperatively, the arm was immobilized by application of an arm brace for six weeks and Codman-type exercises were initiated. When last reviewed at 16 months post-operatively the patient did not report any symptoms. Radiographs of the humerus showed complete fracture healing and consolidation (Fig. 3).