Distal Humerus Fractures in Maintenance Hemodialysis Patients with Forearm Arteriovenous Shunts: Two Case Reports

BACKGROUND Surgical management of distal humerus fractures in hemodialysis patients with an ipsilateral arteriovenous shunt is challenging due to shunt injury and bleeding risks. Treatment selection requires careful patient evaluation and arteriovenous fistula (AVF) preservation. This report describes 2 such cases managed with open reduction and internal fixation using locking plates. CASE REPORT Case 1: A 62-year-old man with chronic renal failure sustained an AO type C1 distal humerus fracture in the shunt-bearing limb. Surgery was performed in the supine position without a tourniquet, using medial and lateral approaches with double locking plates. At final follow-up, elbow motion was 120° flexion, 0° extension, 90° pronation, and 90° supination. Grip strength was 77.3% of the contralateral side. The visual analog scale (VAS), Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) score, and Mayo Elbow Performance Score (MEPS) were 0, 0, and 100, respectively. Radiographs confirmed bone union. Case 2: A 64-year-old woman with chronic renal failure sustained an AO type A2 fracture in the shunt-bearing limb. The same surgical approach was used. At final follow-up, elbow motion was 135° flexion, -5° extension, 85° pronation, and 85° supination. Grip strength was 100% of the contralateral side. The VAS, Q-DASH, and MEPS were 1, 9.09, and 85, respectively. Radiographs confirmed bone union. CONCLUSIONS Locking plate fixation via medial and lateral approaches in the supine position, without tourniquet use, produced favorable outcomes in both cases. This technique may help to preserve AVF function while ensuring stable fixation and satisfactory functional recovery.