抄録
Humeral medial condyle fractures in severely affected patients with rheumatoid arthritis (RA), following minor trauma or occurring spontaneously, have been reported in recent years. Thinning and mutilating deformities of the distal humeral bony structure are considered to be the major causative factors. It is unknown whether osteosynthesis or arthroplasty is superior as treatment. We herein report some early-term results about open reduction and internal fixation (ORIF) using an anatomical plate, which was employed exclusively for two patient cases of humeral medial condyle fracture. The cases involved two elderly women of 76 and an 86 years of age with mutilating RA of Larsen grade 5. From a posteromedial approach in a lateral position, following anterior transposition of the ulnar nerve, the fracture fragment was fixed with an anatomical plate for each patient, respectively. At the postoperative 1-year follow-up for case 1, and the 9 months follow-up for case 2, the range of motion with respect to flexion and extension was 115/−50° and 134/−28°, and the JOA scores were 49 and 61 points, respectively. Radiographically, bone fusion in both cases was not confirmed. The poorest outcome was nonunion with an obvious radiolucent zone around the screws in case 2. Fortunately, these patients were asymptomatic in the operated areas within their limited scope of activity. At a minimum, both patients regained a level of activity equivalent to their preoperative level of Steinbrocker Class 4. These cases suggest that ORIF for humeral medial condyle fractures in severely destructive RA of the elbow may pose challenges from the perspective of bone union. ORIF should be used with caution and only when artificial arthroplasty is contraindicated.
