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Case Reports in Orthopedics
Volume 2013, Article ID 690906, 4 pages
Case Report

Distal Humeral Fixation of an Intramedullary Nail Periprosthetic Fracture

Department of Trauma & Orthopaedic Surgery, East Lancashire Hospitals NHS Trust, Haslingden Road, Blackburn BB2 3HH, UK

Received 7 March 2013; Accepted 25 March 2013

Academic Editors: K. Erler, D. A. Fisher, J. Mayr, and A. Sakamoto

Copyright © 2013 Hiren M. Divecha and Hans A. J. Marynissen. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Distal humeral periprosthetic fractures below intramedullary nail devices are complex and challenging to treat, in particular due to the osteopenic/porotic nature of bone found in these patients. Fixation is often difficult to satisfactorily achieve around the intramedullary device, whilst minimising soft tissue disruption. Descriptions of such cases in the current literature are very rare. We present the case of a midshaft humeral fracture treated with a locking compression plate that developed a nonunion, in a 60-year old female. This went on to successful union after exchange for an intramedullary humeral nail. Unfortunately, the patient developed a distal 1/5th humeral periprosthetic fracture, which was then successfully addressed with a single-contoured, extra-articular, distal humeral locking compression plate (Synthes) with unicortical locking screws and cerclage cables proximally around the distal nail tip region. An excellent postoperative range of motion was achieved.