Interposition Arthroplasty in an Acute Setting to Treat Unexpected Denuded Distal Humerus Articular Cartilage After AO 13C2.2 Distal Humerus Fracture, Surgical Technique, and a Case Report

Abstract

Restoring elbow joint motion is paramount for upper extremity optimum function. In end-stage elbow disease and stiffness, total elbow arthroplasty is the recommended option for older patients; however, for younger, highly demanding patients, interposition arthroplasty (IPA) is the management option of choice. We report a case of an 16-year-old female patient who presented after she had an open-grade IIIA, type AO 13C2.2 distal humerus fracture, which was managed initially by debridement and a cross-elbow external fixation. The decision was made to manage the fracture by open reduction and internal fixation through a posterior approach, and after performing an olecranon osteotomy, the surgeon found that the distal humerus segment was denuded of articular cartilage, so a decision was made after consulting the patient's parents to perform an IPA using fascia lata. At the final follow-up after 16 months, the fracture united completely, and the elbow ROM was from 15° to 120°. Interposition arthroplasty is a valid option to manage unexpected denuded distal humerus articular cartilage while managing distal humerus fractures.

Keywords: case report; denuded articular surface; elbow mobility; interposition arthroplasty.

Figure 1.

Preoperative evaluations. Note. (a) Clinical image of the elbow showing the maximum range of motion and the skin condition. Imaging studies of the elbow joint ((b) plain radiographs and (c) computed tomography) show the AO 13C2.2 fracture of the distal humerus with metaphyseal comminution.

Figure 2.

Intraoperative surgical details. Note. (a) After approaching the elbow through a direct posterior approach and an olecranon osteotomy (red arrowheads), a denuded distal humerus articular cartilage was present (black arrowhead). (b) The harvested fascia lata was folded and held by sutures (yellow arrowhead). (c) The fascia lata was applied to the distal humerus surface and tied to the bone using transosseous sutures (yellow arrowhead). (d) Fracture fixation was completed using posterolateral and medial plates and screws; the metaphyseal defect was compensated by a cortico-cancellous iliac bone strut graft (yellow box). The (e) maximum elbow extension and (f) functional flexion obtained intraoperatively after fixation completion and reattachment of the olecranon osteotomy.

Figure 3.

Postoperative and follow-up evaluations. Note. (a) Immediate postoperative elbow plain radiographs (anteroposterior and lateral views) showing accepted alignment and reduction of the fracture. (b) Last follow-up radiographic assessment showing fracture union, maintenance of the plates and screws position, and preserved elbow joint space. (c) Elbow range of motion (maximum flexion and extension) at the last follow-up. (d) Surgical incision status at the last follow-up (red arrowhead showing the iliac graft incision, blue arrowhead showing the incision for harvesting fascia lata, and the black arrowhead showing the incision for the posterior approach to the elbow).