Aptis 桡肘远端关节置换术后的假体周围尺骨骨折：四例系列病例

Q3 Medicine

Journal of Hand Surgery Global Online Pub Date : 2024-11-01 DOI:10.1016/j.jhsg.2024.06.012

Tan Chern Yang Harmony MD , Matthew Pina MD , Tuna Ozyurekoglu MD , Elkin J. Galvis MD

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引用次数: 0

摘要

目的本病例系列介绍了四例 Aptis 放射锁骨远端关节 (DRUJ) 人工关节置换术后发生的假体周围尺骨骨折病例，以阐明这种罕见并发症的临床特征、诱因、管理挑战和短期疗效，并提出预防和最佳治疗策略。我们确定了四例假体周围尺骨骨折病例，并评估了人口统计学、手术适应症、骨折时间、损伤机制、放射学检查结果、治疗方式、相关并发症和预后。所有患者都曾在同一肢体上接受过手术。骨折发生在DRUJ关节置换术后的11个月内，损伤机制各不相同，其中一名患者是摔倒后骨折，另一名患者是提重物时骨折，其余两名患者是无诱因骨折。术后X光片显示，所有病例都存在骨干偏心位置和骨膜内撞击。根据假体周围骨折统一分类系统，确诊时有三例属于B1型，一例属于B2型。结论术中的技术误区可能会在术后早期导致假体周围尺骨骨折。结论：术中的技术误区可能会导致术后早期的假体周围尺骨骨折，同时也应考虑解剖变异和尺骨轴的形态。非手术治疗的结果并不令人满意，而通过切开复位、内固定和自体骨移植治疗无严重骨干松动的骨折，可实现可靠的骨折结合，这表明保守治疗的作用有限。根据其他部位假体周围骨折的治疗原则，有骨干严重松动的骨折可能最好采用假体置换术，并辅以或不辅以切开复位和内固定术；然而，还需要更多证据来指导这种DRUJ关节成形术罕见并发症的治疗。

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Periprosthetic Ulna Fractures Following Aptis Distal Radioulnar Joint Arthroplasty: A Series of Four Cases

Purpose

This case series presents four cases of periprosthetic ulna fractures following Aptis distal radioulnar joint (DRUJ) arthroplasty to elucidate clinical characteristics, contributing factors, management challenges, and short-term outcomes following this rare complication and to propose prevention and optimal treatment strategies.

Methods

We conducted a retrospective review of 239 Aptis DRUJ prostheses implanted between 2012 and 2022 at a single institution. We identified four cases of periprosthetic ulna fractures and assessed demographics, surgical indications, time to fracture, mechanism of injury, radiographic findings, treatment modalities, associated complications, and outcomes.

Results

The incidence of periprosthetic ulna fractures was 1.7%. All patients had prior surgery on the same extremity. Fractures occurred within 11 months of DRUJ arthroplasty, with varied mechanisms of injury, including one after a fall, another with heavy lifting, and the remaining two unprovoked. Postoperative radiographs revealed eccentric stem position and endosteal impingement in all cases. According to the Unified Classification System for periprosthetic fractures, three were classified as B1 type, and one was B2 type at diagnosis. Open reduction and internal fixation reliably achieved union at an average of 7 months with acceptable function.

Conclusion

Intraoperative technical pitfalls may contribute to periprosthetic ulna fractures during the early postoperative period. Consideration should also be given to anatomical variations and ulna shaft morphometry. Nonsurgical treatment yielded unsatisfactory results, whereas fractures without gross stem loosening treated with open reduction and internal fixation and autologous bone grafting resulted in reliable fracture union, suggesting a limited role for conservative treatment. Based on principles of periprosthetic fracture treatment in other locations, fractures with gross stem loosening may be best managed with implant exchange, with or without supplemental open reduction and internal fixation; however, more evidence is needed to guide the treatment of this rare complication of DRUJ arthroplasty.