CLINICAL CASES   

Minerva Ortopedica e Traumatologica 2006 February;57(1):17-20

Copyright © 2006 EDIZIONI MINERVA MEDICA

language: English

Dislocation after internal fixation for nonunion of the humeral supracondylar fracture in a patient with Parkinson’s disease. A case report

Namba J. ¹, Kitada Y. ¹, Murase T. ², Moritomo H. ², Satoh I. ¹, Tsuda T. ¹

¹ Department of Orthopaedic SurgeryMinoh City Hospital, Minoh, Osaka, Japan 2 Department of Orthopaedic Surgery Osaka University Graduate School of Medicine Osaka, Japan

Treatment of orthopedic problems in patients with Parkinson’s disease is troublesome, including failure of fixation or prosthetic dislocation. Numerous reports indicate a high incidence of hip fracture in Parkinson’s disease patients. There are only few reports in the literature regarding upper extremity problems in this patient population. We describe a rare case of dislocation of the elbow joint after internal fixation for nonunion of the humeral supracondylar fracture in an 83-year old woman with Parkinson’s disease. She had a low-energy fall sustaining a nondisplaced supracondylar fracture of right distal humerus. Her Hoehn and Yahr score was graded stage 4. She was initially treated with cast immobilization. Follow-up radiographs demonstrated a nonunion of her fracture with severe displacement. Two months after her injury, internal fixation was performed. At the postoperative follow-up examination, the radiographs revealed that her elbow was dislocated while the fracture site was stable. The dislocation was impossible to reduce by closed method. Further surgical treatment was abandoned and free mobilization of the elbow was permitted although the elbow remained dislocated. This compromise in outcome might result from surgical invasion in combination with the pre-existing conditions, including neurological disorder characterized by tremor at rest and increased rigidity and preoperative elbow contracture.