Harmony Tan Chern Yang, Pina Matthew, Ozyurekoglu Tuna, Galvis Elkin J
Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, KY.
J Hand Surg Glob Online. 2024 Aug 17;6(6):823-829. doi: 10.1016/j.jhsg.2024.06.012. eCollection 2024 Nov.
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.
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.
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.
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.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
本病例系列介绍了4例Aptis远侧尺桡关节（DRUJ）置换术后假体周围尺骨骨折的病例，以阐明这一罕见并发症的临床特征、促成因素、管理挑战和短期预后，并提出预防和最佳治疗策略。
我们对2012年至2022年在单一机构植入的239个Aptis DRUJ假体进行了回顾性研究。我们确定了4例假体周围尺骨骨折病例，并评估了人口统计学特征、手术指征、骨折时间、损伤机制、影像学表现、治疗方式、相关并发症和预后。
假体周围尺骨骨折的发生率为1.7%。所有患者此前均在同一肢体上接受过手术。骨折发生在DRUJ置换术后11个月内，损伤机制各不相同，包括1例跌倒后、1例重物搬运后，其余2例无明显诱因。术后X线片显示所有病例均有假体柄偏心位和骨内膜撞击。根据假体周围骨折统一分类系统，诊断时3例为B1型，1例为B2型。切开复位内固定平均7个月可靠愈合，功能可接受。
术中技术失误可能导致术后早期假体周围尺骨骨折。还应考虑解剖变异和尺骨干形态学。非手术治疗效果不理想，而对于假体柄无明显松动的骨折，切开复位内固定并自体骨移植可实现可靠的骨折愈合，提示保守治疗作用有限。基于其他部位假体周围骨折的治疗原则，对于假体柄明显松动的骨折，最好进行假体置换，可联合或不联合补充切开复位内固定；然而，需要更多证据来指导DRUJ置换术这一罕见并发症的治疗。
研究类型/证据水平：治疗性IV级。
