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Müller LP, Wegmann K, Burkhart KJ. [Fracture endoprosthesis of distal humerus fractures]. Unfallchirurg 2013; 116:708-15. [PMID: 23934533 DOI: 10.1007/s00113-013-2411-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The treatment of choice for fractures of the distal humerus is double plate osteosynthesis. Due to anatomical preshaped angle stable plates the primary stability and management of soft tissues has been improved. However, osteoporotic comminuted fractures in the elderly are often not amenable to stable osteosynthesis and total elbow arthroplasty has been established as an alternative therapy. Although complication rates have been reduced, complications of total elbow arthroplasty are still much more frequent than in total hip replacement. Furthermore, patients are advised not to exceed a weight bearing of 5 kg. Therefore, the indications for elbow arthroplasty must be evaluated very strictly and should be reserved for comminuted distal humeral fractures in the elderly with poor bone quality that are not amenable to stable osteosynthesis or for simple fractures in cases of preexisting symptomatic osteoarthritis. This article introduces and discusses modern concepts of elbow arthroplasty, such as modular convertible prosthesis systems, hemiarthroplasty and radial head replacement in total elbow arthroplasty.
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Affiliation(s)
- L P Müller
- Unfall-, Hand- und Ellenbogenchirurgie, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Köln, Kerpener Straße 62, Köln, Germany.
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202
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Riedel K, Beaton DE. Update on the state of outcome measurement in total elbow arthroplasty research: identifying a need for consensus. J Bone Joint Surg Am 2013; 95:e97 1-8. [PMID: 23864188 DOI: 10.2106/jbjs.k.01420] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is little consensus for a standard set of metrics to express outcome after total elbow arthroplasty. In order to set the stage for future work toward a core set of measurement tools, our goal was to gather a complete view of the outcomes used in total elbow arthroplasty research, the concepts of their focus, and their quality as measures of the target concept. METHODS We reviewed the outcome measures for total elbow arthroplasty presented in the literature from 2004 to 2011 in terms of the instruments used and their concepts of focus. We reviewed the reliability, validity, and responsiveness of the prevailing measurement tools. RESULTS Of the seventy-two articles identified, 90% (sixty-five) used elbow-specific aggregate outcome measures, which combine concepts, such as physiological variables, with symptom status and functional status. The Mayo Elbow Performance Score, or a variation of that scoring system, was used in fifty-four (75%) of the seventy-two articles. Most outcomes pertained to biological and physiological variables, with fewer outcomes focusing on symptoms, function, or overall health status. A review of the measurement properties of the elbow-specific aggregate outcome measures did not reveal one to be superior. CONCLUSIONS Overall, total elbow arthroplasty outcomes are heterogeneous in their reporting and lack standardization. The total elbow arthroplasty literature relies on several physician-derived elbow-specific aggregate measures and focuses primarily on physiological variables. The relative merits of aggregating findings into a single scoring system versus as separate components should be explored further. Finally, consideration should be given to patient-reported outcome measures in total elbow arthroplasty research. CLINICAL RELEVANCE This study of the current "state of practice" for outcome measurement in total elbow arthroplasty revealed gaps in the breadth of measurement and a lack of comparability in elbow scoring systems that could hinder our ability to clearly and fully understand outcome after total elbow arthroplasty. Future consensus work could address both concerns and assist in the development of a core set of outcome measures.
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Affiliation(s)
- Kelly Riedel
- Mobility Clinical Research Unit, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, Canada.
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203
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DeSimone LJ, Sanchez-Sotelo J. Total elbow arthroplasty for distal humerus fractures. Orthop Clin North Am 2013; 44:381-7, ix-x. [PMID: 23827840 DOI: 10.1016/j.ocl.2013.03.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Total elbow arthroplasty has become increasingly popular for the treatment of distal humerus fractures in elderly patients with poor bone quality, comminution, and/or pre-existent elbow abnormalities. The procedure is performed without violating the extensor mechanism; the fractured fragments are exposed and resected on both sides of the triceps, and the components can be implanted through the same exposure. Early outcomes are satisfactory in most elbows and compare favorably with internal fixation in this same group of elderly patients. Advances in elbow arthroplasty for fractures will likely combine refinement of the indications and development of implants with lower rates of failure.
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Affiliation(s)
- Lori J DeSimone
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN, USA
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204
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Mora-Navarro N, Sánchez-Sotelo J. [Elbow replacement]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2013; 56:413-20. [PMID: 23594898 DOI: 10.1016/j.recot.2012.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 06/28/2012] [Indexed: 11/16/2022] Open
Abstract
Elbow replacement or arthroplasty is a good therapeutic option for a large percentage of patients with significant joint destruction. However, many orthopaedic surgeons are no familiar with the surgical approaches or techniques associated with elbow replacement implants. Furthermore, the incidence of complications is higher than in other joint replacements, the most important being infections, mechanical failure, cubital neuropathy, and problems with the triceps. For these reasons, the use of bone arthroplasty in Spain may be less than ideal. Although, inflammatory arthritic diseases, such as rheumatoid arthritis, are the most frequent indication for this operation, distal humerus fractures and post-traumatic disease are a growing indication. This work attempts to summarise the most important current concepts associated with elbow replacement.
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Affiliation(s)
- N Mora-Navarro
- Departamento de Cirugía Ortopédica, Clínica Mayo, Rochester, Estados Unidos
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205
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Ducrot G, Bonnomet F, Adam P, Ehlinger M. Treatment of distal humerus fractures with LCP DHP™ locking plates in patients older than 65 years. Orthop Traumatol Surg Res 2013; 99:145-54. [PMID: 23453914 DOI: 10.1016/j.otsr.2012.12.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 07/27/2012] [Accepted: 12/30/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Fractures of the distal humerus are often complex and therefore challenging to treat. In elderly patients with decreased bone strength due to osteoporosis, strong fixation is crucial to allow resuming early motion that guarantees a good functional outcome as well as minimising mechanical complications. Locked implants meet these requirements. Here, we report outcomes in a uniform series of patients older than 65 years with distal humerus fractures managed with LCP DHP(®) (Synthès) fixation. Our objective was to evaluate the efficacy and limitations of this technique. HYPOTHESIS LCP DHP provides strong fixation of osteoporotic bone and leads to good clinical and radiological outcomes. MATERIALS AND METHODS We retrospectively studied 46 consecutive patients (2004-2010) with a mean age of 80 years including 15 with extra-articular and 31 with articular distal humerus fractures. At presentation, 11 complications were noted in nine patients (compound fractures and trauma-related nerve injuries). The transolecranon approach was used in 31 patients. Mean duration of immobilisation was 2.7 weeks in 33 patients. RESULTS Forty-three patients were re-evaluated after a mean follow-up of 25 months (range, 10-64 months); two patients died and one was lost to follow-up. Flexion was 127° and loss of extension was 23°, producing an average range of motion of 104°. Functional recovery was highly satisfactory with a Mayo Clinic Performance Score of 87 (70-100) and 95% of good and very good results. Postoperative complications consisted of infection (n=3), metaphyseal non-union (n=2), ulnar nerve injury (n=6), transient radial nerve palsy (n=1), and peri-articular ossification (n=4). Compound fracture and worse AO fracture type were associated with worse functional outcomes. DISCUSSION Despite the high complication rate, functional recovery was similar to that reported in previous case series, including after arthroplasty. Furthermore, the rate of mechanical complications was lower. Thus, our working hypothesis was confirmed. LEVEL OF EVIDENCE Level IV retrospective non-comparative study.
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Affiliation(s)
- G Ducrot
- Department of Orthopaedic and Trauma Surgery, de Hautepierre Hospital, Strasbourg Academic Hospital Group, 1, avenue Molière, 67098 Strasbourg, France.
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206
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Ducrot G, Ehlinger M, Adam P, Di Marco A, Clavert P, Bonnomet F. Complex fractures of the distal humerus in the elderly: is primary total elbow arthroplasty a valid treatment alternative? A series of 20 cases. Orthop Traumatol Surg Res 2013; 99:10-20. [PMID: 23273377 DOI: 10.1016/j.otsr.2012.10.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 07/24/2012] [Accepted: 10/05/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Distal humerus fractures are fairly rare. But as our population ages, these fractures become more complex and the choice of treatment more delicate. Poor bone quality results in many technical problems and the fixation hardware stability remains at risk. The goal of this study was to evaluate the functional recovery and morbidity of complex distal humerus fractures in elderly patients when treated with elbow prosthesis. HYPOTHESIS Good functional recovery can be achieved with a total joint replacement. PATIENTS AND METHODS This series consisted of 20 patients (18 women and two men) having an average age of 80years (range 65-93, median 80). Based on the AO classification, there were two Type A2 fractures, two Type B fractures, 15 Type C fractures and one fracture that could not be classified because of previous rheumatoid disease history at this elbow. Two fractures were open. In two cases, the olecranon was also fractured. Treatment consisted of the implantation of a Coonrad-Morrey, hinge-type total elbow prosthesis (Zimmer(®), Warsaw, IN, USA). The Mayo Clinic surgical approach was used 17 times and the transolecranon approach was used three times. Primary arthroplasty was performed in 19 cases and the surgery was performed after six weeks of conservative treatment (diagnostic delay) in one case. Unrestricted motion was allowed after surgery, but a maximum of 0.5kg could be carried during the first 3months; this was subsequently increased to 2.5kg. RESULTS Fifteen of the 20 patients were available for reevaluation with an average follow-up of 3.6years (range 1.7-5.5, median 3.4). Four patients had died and one was lost to follow-up. The average range of motion was 97° (range 60-130°), comprising an average flexion of 130° (range 110-140°) and average loss of extension of 33° (range 0-80°). Pronation and supination were normal. The average Mayo Elbow Performance Score (MEPS) was 83 (range 60-100, median 80). X-rays revealed seven cases of radiolucent lines, with two being progressive. There was no visible wear of the polyethylene bushings at the hinge. Six patients had moderate periarticular heterotopic ossification. The two cases of olecranon osteotomy and one case of olecranon fracture had healed. There were no surgical site infections but two cases of ulnar compression, one of which required neurolysis. There was one case of humeral component loosening after 6years, but the implant was not changed. DISCUSSION The clinical range of motion results were comparable to published data. The functional scores were slightly lower, mainly because of the pain factor. The initial results were encouraging and consistent with published data as long as the indications were well-chosen. Based on this retrospective study, total elbow arthroplasty can be a valid alternative in the surgeon's treatment armamentarium for complex distal humerus fractures in elderly patients who have moderate functional demands. Our results support our hypothesis, since we found good functional recovery without associated morbidity. LEVEL OF EVIDENCE Level IV retrospective study without comparator.
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Affiliation(s)
- G Ducrot
- Orthopaedic and Trauma Surgery Department, Hautepierre Hospital, Strasbourg University Hospitals, 1, avenue Molière, 67098 Strasbourg, France.
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207
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Abstract
BACKGROUND Distal humeral fractures in adults are relatively uncommon injuries that require surgical intervention in most cases. There is a lack of consensus regarding the best management of distal humeral fractures in adults, including the role of conservative treatment, appropriate surgical approach, fixation strategies, the role of total elbow arthroplasty and handling of nerves such as the ulnar nerve. OBJECTIVES To assess the effects (benefits and harms) of surgical interventions for distal humeral fractures in adults. SEARCH METHODS We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (May 2012), the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2012 Issue 4), MEDLINE (1946 to April Week 4 2012), EMBASE (1980 to 2012 Week 17), Current Controlled Trials (1st May 2012), the WHO International Clinical Trials Registry Platform (1st May 2012) and the bibliographies of trial reports and relevant articles. SELECTION CRITERIA All randomised and quasi-randomised controlled trials pertinent to the management of distal humeral fractures in adults were included. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, assessed of risk of bias and extracted data. Pooling of data was impossible due to study heterogeneity. MAIN RESULTS Three small randomised controlled trials, with a total of 109 participants with Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen (OTA/AO) type C distal humeral fractures, were included. Overall, the quality of the available evidence is limited. As well as the small sample sizes and detection bias from the lack of blinding of subjective outcomes, the methods and results of all three trials were incompletely reported.One trial, involving 42 participants, compared open reduction-internal fixation (ORIF) with total elbow arthroplasty (TEA) in patients aged over 65 years. Of the 40 participants followed up for two years, five allocated ORIF underwent intraoperative conversion to TEA. These participants were crossed-over to the TEA group in the analyses. The reported Mayo Elbow Performance Score (MEPS) results were consistently better in the TEA group at follow-up after 6, 12, and 24 months, whereas the Disability of the Arm, Shoulder, Hand (DASH) scores showed short term (after 6 months), but not longer term (after 12 and 24 months), superiority in the TEA group. The reoperation rate, complication rate and elbow range of motion results showed no statistically significant differences between the two groups. While an intention-to-treat analysis of treatment failure, where the five cross-over participants are placed in their original allocated group, is in favour of TEA, the result did not reach statistical significance (9/21 versus 3/21; RR 3.00, 95% CI 0.94 to 9.55).The second trial, involving 38 patients but reporting results for 35, compared perpendicular versus parallel double plate fixation strategies. There was a consistent finding of a lack of significant differences between the two treatment groups in terms of MEPS, re-operation for complications (3/17 versus 3/18; RR 1.06, 95% CI 0.25 to 4.54), complications and elbow joint range of motion.The third trial, which included 29 patients with preoperative ulnar nerve compression symptoms, compared anterior subfascial transposition with in situ decompression of the ulnar nerve. Although results for complete recovery of ulnar nerve function (12/15 versus 8/14; RR 1.4, 95% CI 0.83 to 2.35) and grades based on the Bishop rating system tended to favour the transposition group, none of the differences were statistically significant. AUTHORS' CONCLUSIONS Overall, this review found there is either no or insufficient evidence from randomised or quasi-randomised controlled trials to determine whether surgery is, and which surgical interventions are, the most appropriate for the management of different types of distal humerus fractures. Well designed and reported large and multi-centre randomised controlled trials testing current interventions, such as pre-contoured and locking plating systems, are needed.
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Affiliation(s)
- Yan Wang
- Department of Orthopaedic Surgery, Chinese PLA General Hospital, Beijing, China
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208
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Argintar E, Berry M, Narvy SJ, Kramer J, Omid R, Itamura JM. Hemiarthroplasty for the treatment of distal humerus fractures: short-term clinical results. Orthopedics 2012; 35:1042-5. [PMID: 23218618 DOI: 10.3928/01477447-20121120-06] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Total elbow arthroplasty is the current gold standard of treatment for unreconstructable distal humerus fractures; however, longevity of the implant remains a concern in younger, more active patients. Distal humerus hemiarthroplasty offers an alternative and may allow for more durable results. The authors retrospectively evaluated the short-term clinical outcomes of 10 patients who underwent elbow hemiarthroplasty for distal humerus fractures. This short-term review suggests that distal humerus hemiarthroplasty may be an effective treatment for certain distal humerus fractures. Additional studies must be conducted to further define the role of elbow hemiarthroplasty for the treatment of complex fractures of the distal humerus.
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Affiliation(s)
- Evan Argintar
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, USA.
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209
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Dietz SO, Burkhart KE, Nowak TE, Rommens PM, Müller LP. Distal humerus fractures in the elderly: osteosynthesis or endoprosthesis? Review of the literature. Eur J Trauma Emerg Surg 2012; 38:605-15. [PMID: 26814545 DOI: 10.1007/s00068-012-0216-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 07/02/2012] [Indexed: 10/28/2022]
Abstract
Fractures of the distal humerus in adults are rare but challenging for the orthopaedic trauma surgeon. The bimodal distribution reflects the trauma mechanism. While distal humerus fractures are caused by high-energy traumata in young male adults, a fall from a standing height is the most common reason for humerus fractures among elderly females. As a rule, fractures of the distal humerus are treated surgically. In young patients, open reduction and internal fixation (ORIF) with anatomic locking plates are the gold standard. In elderly patients, reconstruction is not always possible, and total elbow arthroplasty (TEA) becomes necessary. The present article provides an overview of the current diagnostic and treatment recommendations. The current literature is reviewed and the results discussed.
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Affiliation(s)
- S O Dietz
- Center of Musculoskeletal Surgery, University Medical Center, Johannes Gutenberg-University, Mainz, Germany.
| | - K E Burkhart
- Department of Orthopedic and Trauma Surgery, University of Cologne, Cologne, Germany
| | - T E Nowak
- Center of Musculoskeletal Surgery, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - P M Rommens
- Center of Musculoskeletal Surgery, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | - L P Müller
- Department of Orthopedic and Trauma Surgery, University of Cologne, Cologne, Germany
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210
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Abstract
Management of coronal shear fractures of the distal humerus has evolved considerably over the past 3 decades, with an increased appreciation of the complexity of these fractures, improvements in internal fixation techniques, and the use of more extensile exposures. Nearly all of these fractures are displaced, given the paucity of soft tissue attachments and correspondingly, nonsurgical management is fraught with complications including chronic pain, mechanical symptoms, and instability and is not recommended. Good to excellent outcomes can be achieved in the majority of patients with open reduction internal fixation, particularly when the fracture is limited to the radiocapitellar joint. Outcomes are worst for those with considerable medial extension or comminution. Computed tomography is highly recommended to guide surgical planning. The presence of posterior comminution or extension to the medial column might require more extensile exposures and supplemental fixation for adequate stability. Arthroscopic reduction and fixation techniques have been described for the simple fracture. Those not amenable to fixation might do better with total elbow arthroplasty in a select population. Long-term data demonstrate the durability of these elbows following open reduction internal fixation. Complications other than stiffness are rare. Radiographic avascular necrosis does not appear to affect outcome. Radiographic mild to moderate arthritis was observed in half of patients at 17-year follow-up.
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Affiliation(s)
- John J Lee
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109-5328, USA.
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211
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Sabo MT, Athwal GS, King GJW. Landmarks for rotational alignment of the humeral component during elbow arthroplasty. J Bone Joint Surg Am 2012; 94:1794-800. [PMID: 23032590 DOI: 10.2106/jbjs.j.01740] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The reference points for rotational orientation of the humeral component during elbow arthroplasty typically are on the articular surface or the humeral epicondyles. With bone loss, these landmarks may be compromised. Our purpose was to assess whether the flat posterior humeral cortex proximal to the olecranon fossa is a reliable landmark with which to orient the humeral component during elbow arthroplasty. METHODS Fifty cadaveric elbows (mean age [and standard deviation] at the time of death, 73 ± 12 years) underwent computed tomography (CT) scans. The flexion-extension axis (FEA) was determined by sphere-fitting the capitellar surface and circle-fitting the narrowest portion of the trochlea. The posterior humeral cortical line (PCL) was drawn on the flat posterior humeral cortex proximal to the olecranon fossa. The transepicondylar axis (TEA) was determined by a line between the most prominent points on the epicondyles. The angles between the PCL and FEA and the TEA and FEA were calculated and were compared by using two-tailed t tests. RESULTS The PCL was externally rotated by a mean (and standard deviation) of 14.0° ± 4.2° (p < 0.001) relative to the FEA (males: 12.6° ± 3.6°, females: 16.4° ± 5.2°; p = 0.002). The TEA was externally rotated by a mean of 2.8° ± 3.5° (p < 0.001) relative to the FEA (males: 2.7° ± 3.4°, females: 2.6° ± 3.7°; p = 0.96). The intraobserver and interobserver reliability was >0.98 for the capitellar and trochlear centers, while the cumulative intraobserver and interobserver reliability was 0.8 and 0.5 for the FEA-PCL angle and 0.4 and 0.3 for the FEA-TEA angle. CONCLUSIONS The posterior humeral cortex is a reproducible landmark that is externally rotated with respect to the flexion-extension axis of the distal part of the humerus. The surgeon must be aware of the need for an internal rotation correction factor and consider the influence of the patient's sex on this correction when using the posterior humeral cortex as a landmark to avoid humeral component malrotation. CLINICAL RELEVANCE While the PCL is better than the TEA as a reference point, neither is able to accurately identify the FEA because of considerable normal variation. Future studies are needed to evaluate the effectiveness of computer-assisted techniques or a preoperative CT scan of the contralateral, unaffected elbow in identifying rotational landmarks for the elbow undergoing arthroplasty.
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Affiliation(s)
- Marlis T Sabo
- Hand and Upper Limb Centre, St. Joseph's Health Care, 268 Grosvenor Street, Suite D0-202, London, ON N6A 4L6, Canada
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212
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Balogh ZJ, Reumann MK, Gruen RL, Mayer-Kuckuk P, Schuetz MA, Harris IA, Gabbe BJ, Bhandari M. Advances and future directions for management of trauma patients with musculoskeletal injuries. Lancet 2012; 380:1109-19. [PMID: 22998720 DOI: 10.1016/s0140-6736(12)60991-x] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Musculoskeletal injuries are the most common reason for operative procedures in severely injured patients and are major determinants of functional outcomes. In this paper, we summarise advances and future directions for management of multiply injured patients with major musculoskeletal trauma. Improved understanding of fracture healing has created new possibilities for management of particularly challenging problems, such as delayed union and non union of fractures and large bone defects. Optimum timing of major orthopaedic interventions is guided by increased knowledge about the immune response after injury. Individual treatment should be guided by trading off the benefits of early definitive skeletal stabilisation, and the potentially life-threatening risks of systemic complications such as fat embolism, acute lung injury, and multiple organ failure. New methods for measurement of fracture healing and function and quality of life outcomes pave the way for landmark trials that will guide the future management of musculoskeletal injuries.
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Affiliation(s)
- Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia.
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213
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Mora Navarro N, Sánchez-Sotelo J. Elbow replacement. Rev Esp Cir Ortop Traumatol (Engl Ed) 2012. [DOI: 10.1016/j.recote.2012.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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214
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Complex distal humerus fractures in elderly patients: open reduction and internal fixation versus arthroplasty. J Hand Surg Am 2012; 37:1699-701. [PMID: 22284750 DOI: 10.1016/j.jhsa.2011.11.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 11/21/2011] [Indexed: 02/02/2023]
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215
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Fajolu O, Iyengar K, Litts CS. Distal humerus fractures: handling of the ulnar nerve. J Hand Surg Am 2012; 37:1696-8. [PMID: 22305727 DOI: 10.1016/j.jhsa.2011.11.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 11/21/2011] [Indexed: 02/02/2023]
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216
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Wiggers JK, Brouwer KM, Helmerhorst GTT, Ring D. Predictors of diagnosis of ulnar neuropathy after surgically treated distal humerus fractures. J Hand Surg Am 2012; 37:1168-72. [PMID: 22522105 DOI: 10.1016/j.jhsa.2012.02.045] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 02/24/2012] [Accepted: 02/29/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE Ulnar nerve dysfunction is a common sequela of surgical treatment of distal humerus fractures. This study addresses the null hypothesis that different types of distal humerus injuries have comparable rates of diagnosis of ulnar neuropathy. METHODS We assessed diagnosis of ulnar neuropathy in 107 consecutive adults who had a surgically treated fracture of the distal humerus followed up at least 6 months after injury. Diagnosis of ulnar neuropathy was defined as documentation of sensory and motor dysfunction of the ulnar nerve in the medical record. Fractures were categorized as either columnar fractures or fractures of the capitellum and trochlea. The explanatory (independent) variables included age, sex, fracture type, AO type, associated wound, associated elbow dislocation, mechanism of trauma, ipsilateral skeletal injury, olecranon osteotomy, implant over or below the medial epicondyle, infection, time from injury to surgery, the number of surgeries within 4 weeks and 6 months of injury, the total number of surgeries, and whether the nerve was transposed. RESULTS Postoperative ulnar neuropathy was diagnosed in 17 of 107 patients (16%), including 16 of 59 columnar fractures (21%). The only risk factor for ulnar neuropathy was columnar fracture. CONCLUSIONS Patients with columnar fractures might be at higher risk for the development of postoperative ulnar neuropathy than patients with capitellum and trochlea fractures, regardless of whether the ulnar nerve was transposed. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Jimme K Wiggers
- Orthopaedic Hand and Upper Extremity Service, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
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Fixing simple olecranon fractures with the Olecranon Osteotomy Nail (OleON). OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2012; 23:438-45. [PMID: 22159902 DOI: 10.1007/s00064-011-0112-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Stable fixation of simple olecranon fractures or olecranon osteotomies in order to allow early functional treatment. INDICATIONS Simple (non-comminuted) olecranon fractures and (Chevron) osteotomies of the olecranon. CONTRAINDICATIONS Comminuted fractures and fractures more than 40 mm distal than the tip of the olecranon are contraindications. SURGICAL TECHNIQUE Using a slightly curved posterior approach, the fracture is anatomically reduced. The fracture is temporary stabilized using K-wires. A guiding K-wire is positioned centrally in the medullary canal in the lateral projection. The medullary canal is reamed over the K-wire. The distal part of the nail is inserted and locked. The proximal part is inserted and screwed onto the distal part to compress the fracture. For osteotomies, the distal part is inserted and locked (using the same technique as described before) prior to performing the osteotomy. At the end of the surgery, the osteotomy is reduced, the proximal part is inserted, and the osteotomy is compressed. POSTOPERATIVE MANAGEMENT As the stability of this compressive osteosynthesis is very high, early post-operative mobilization is allowed. No immobilization is used. Depending on the soft tissue situation, active range of motion and passive stretching is initiated immediately postoperatively. RESULTS Using this technique in 21 patients (mean age 42 years) with acute fractures or osteotomies, sound fracture healing was achieved in 19 of 21 patients. The active range of motion was 130.2° flexion, 10.6° extension deficit, and a normal pro-supination arch. In one patient, delayed union caused implant failure. In this patient, a surgical error jeopardized stability. In a second patient, a peri-implant fracture after adequate trauma made a change in therapy necessary.
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218
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Adolfsson L, Nestorson J. The Kudo humeral component as primary hemiarthroplasty in distal humeral fractures. J Shoulder Elbow Surg 2012; 21:451-5. [PMID: 22005125 DOI: 10.1016/j.jse.2011.07.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Revised: 06/30/2011] [Accepted: 07/10/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND Treatment of intra-articular fractures of the distal humerus in the elderly is challenging. In patients with very distal fractures and severe comminution, primary arthroplasty has been advocated. Recently, a few reports have described promising results of hemiarthroplasty. This study describes the medium-term results of using the Kudo humeral implant (Biomet Ltd, Bridgend, U.K.) as replacement of the distal humerus. MATERIAL AND METHODS Eight women (mean age, 79 years) were treated. Follow-up was conducted at a mean of 4 years after the procedure and consisted of the Mayo Elbow Performance Score (MEPS), radiographic images, and range of motion (ROM). RESULTS All patients had a good or excellent outcome according to the MEPS. Mean ROM was 31° to 126°. Radiographic signs of attrition of the ulna were observed in 3 patients but did not correlate with the functional outcome. A periprosthetic fracture occurred in 1 patient 3 years after the index operation, and ROM was unsatisfactory in 1 patient. No other complications were observed. CONCLUSION The use of the Kudo humeral implant as a hemiarthroplasty resulted in a reasonable functional outcome in the medium-term, but the radiographic signs of attrition suggest that the implant is not recommended as a hemiprosthesis.
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Affiliation(s)
- Lars Adolfsson
- Department of Orthopaedics, Linköping University Hospital, Linköping, Sweden.
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Sanchez-Sotelo J. Distal humeral fractures: role of internal fixation and elbow arthroplasty. J Bone Joint Surg Am 2012; 94:555-68. [PMID: 22438005 DOI: 10.2106/jbjs.946icl] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Joaquin Sanchez-Sotelo
- Department of Orthopaedic Surgery, Gonda 14, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Gay DM, Lyman S, Do H, Hotchkiss RN, Marx RG, Daluiski A. Indications and reoperation rates for total elbow arthroplasty: an analysis of trends in New York State. J Bone Joint Surg Am 2012; 94:110-7. [PMID: 22257996 DOI: 10.2106/jbjs.j.01128] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total elbow arthroplasty was originally used to treat patients with arthritis. As familiarity with total elbow arthroplasty evolved, the indications were expanded to include other disorders. There continues to be a low number of total elbow arthroplasties performed each year in comparison with hip, knee, and shoulder arthroplasties, and few large studies have examined the indications and associated complications of total elbow arthroplasty. The purposes of this study were to evaluate the changes with time in the indications for total elbow arthroplasty and to examine the complications of this procedure in a large database. METHODS The Statewide Planning and Research Cooperative System database from the New York State Department of Health, a census of all ambulatory and inpatient surgical procedures in the state of New York, was used to identify individuals who underwent primary total elbow arthroplasty during the time period of 1997 to 2006. These total elbow arthroplasties were evaluated for admitting diagnoses, sex and age of patient, readmission and complication data, and time to subsequent elbow surgery. RESULTS From 1997 to 2006, there were 1155 total elbow arthroplasties performed in New York State. In 1997, 43% of the total elbow arthroplasties were associated with trauma and 48%, with inflammatory conditions. In 2006, this changed to 69% and 19%, respectively. Within ninety days after the primary total elbow arthroplasty, 12% of the patients were readmitted to the hospital with approximately one-half (5.6%) admitted for problems related to the total elbow arthroplasty. The overall revision rate was 6.4%. The revision rates for the traumatic, inflammatory arthritis, and osteoarthritis groups were 4.8%, 8.3%, and 14.7%, respectively. Of particular interest, 90.5% of the total elbow arthroplasties were performed by surgeons with no recorded experience in the database, which began collecting these data in 1986. CONCLUSIONS This study provides useful information regarding patients undergoing total elbow arthroplasty in New York State. During the study period, the most common indication for total elbow arthroplasty changed from inflammatory arthritis to trauma. Although the number of total elbow arthroplasties being performed each year has increased, there continues to be a high complication and revision rate.
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Affiliation(s)
- David M Gay
- Flagler Orthopedics and Sports Medicine, 61 Memorial Medical Parkway, Palm Coast, FL 32164, USA
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221
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Abstract
In light of the growing number of elderly osteopenic patients with distal humeral fractures, we discuss the history of their management and current trends. Under most circumstances operative fixation and early mobilisation is the treatment of choice, as it gives the best results. The relative indications for and results of total elbow replacement versus internal fixation are discussed.
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Affiliation(s)
- D. Popovic
- Hand and Upper Limb Centre, St.
Joseph’s Health Centre, 268 Grosvenor Street, London, Ontario, N6A
4L6, Canada
| | - G. J. W. King
- Hand and Upper Limb Centre, St.
Joseph’s Health Centre, 268 Grosvenor Street, London, Ontario, N6A
4L6, Canada
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Open reduction and internal fixation compared with primary total elbow arthroplasty for displaced intra-articular fractures of the distal humerus in the elderly. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e31823cd605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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223
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The "anconeus slide": rotation flap for management of posterior wound complications about the elbow. J Shoulder Elbow Surg 2011; 20:1310-6. [PMID: 21396832 DOI: 10.1016/j.jse.2010.11.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 11/18/2010] [Accepted: 11/27/2010] [Indexed: 02/01/2023]
Abstract
BACKGROUND Wound dehiscence at the tip of the olecranon is not an uncommon complication associated with surgical approaches to the elbow that involve a posterior skin incision. Various flaps have been described in the treatment of such soft tissue defects, but have associated morbidity. The "anconeus slide" rotation flap has low morbidity and is technically simple. In this study, we review the surgical technique and describe our experience with the anconeus rotation flap in 20 consecutive patients. METHODS The records of 20 patients who underwent an anconeus rotation flap by a single surgeon, from September 2006 to March 2010 were reviewed. The procedure was performed in the setting of total elbow arthroplasty (TEA) in 12 patients, revision total elbow arthroplasty in 3 patients, wound complications in 4 patients, and for an acute open distal humerus fracture in 1 patient. Patients were evaluated postoperatively for wound healing, pain, and postoperative Mayo Elbow Performance Scores (MEPS). RESULTS All 20 patients healed their surgical wounds completely. Postoperative MEPS scores averaged 79.3 (range, 50-100). CONCLUSION The anconeus rotational flap is a technically simple, reliable, and safe option for treatment of posterior wound complications about the elbow, and in the setting of primary and revision TEA when wound healing is a clinical concern. We recommend its use in patients who have either compromised posterior soft tissue coverage, triceps insufficiency, or factors associated with the potential for compromised wound healing.
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Frattini M, Soncini G, Corradi M, Panno B, Tocco S, Pogliacomi F. Mid-term results of complex distal humeral fractures. Musculoskelet Surg 2011; 95:205-213. [PMID: 21484440 DOI: 10.1007/s12306-011-0132-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Accepted: 03/30/2011] [Indexed: 05/30/2023]
Abstract
The aim of this study was to assess outcomes following open reduction and internal fixation in complex fractures of the distal humerus. Between 2000 and 2006, 34 patients were operated for complex fractures of the distal humerus. Bone fixation was obtained with a reverse Y-shaped reconstruction plate in 13 cases and with double plating in 21 cases. At final follow-up, all the patients were assessed with the Mayo Elbow Performance Score. Satisfactory results were observed in 71% of the cases despite a high rate of complications. Age over 65 years is correlated with increased risk for an inferior postoperative result. Complex distal humeral fractures are difficult to treat and are associated with a high incidence of complications. It is therefore mandatory to obtain good anatomical reduction and a stable fixation of lateral and medial columns of the distal humerus. The results observed in older patients suggest that an alternative treatment for these patients may be joint replacement.
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Affiliation(s)
- Marco Frattini
- Unit of Orthopedic, Traumatology and Functional Rehabilitation, Department of Surgical Sciences, University of Parma, Parma Hospital, Via Gramsci 14, 43100 Parma, Italy.
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Distal Humerus Hemiarthroplasty of the Elbow for Comminuted Distal Humeral Fractures in the Elderly Patient. ACTA ACUST UNITED AC 2011; 71:635-42. [DOI: 10.1097/ta.0b013e318216936e] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Baksi DP, Pal AK, Baksi D. Prosthetic replacement of elbow for intercondylar fractures (recent or ununited) of humerus in the elderly. INTERNATIONAL ORTHOPAEDICS 2011; 35:1171-7. [PMID: 21153549 PMCID: PMC3167422 DOI: 10.1007/s00264-010-1122-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 08/25/2010] [Accepted: 08/25/2010] [Indexed: 10/18/2022]
Abstract
Forty-one patients with an intercondylar fracture of the humerus (21 recent and 20 ununited) were treated by total elbow arthroplasty using Baksi's recent version of the sloppy hinge from January 2003 to April 2009. Twelve were AO classification type C2 and nine were type C3 recent closed fractures of seven days' mean duration according to Muller classification. Patient's mean age was 64 years. There were 20 nonunions (nine untreated nonunions of a mean of 11 months duration and 11 following failed internal fixation of a mean of 14 months duration); mean patient age was 58 years. The follow up period was 12-88 (mean 55.5) months. Mean arc of postoperative elbow flexion was 25-130° obtained in 39 (95.1%) patients. Mean arc of 65° pronation and 60° supination was obtained in 33(80.5%) patients. According to the Mayo elbow performance score, in the fresh-fracture group, excellent results were seen in 19 (90.5%), good in one (4.8%), and failure in one (4.8%), whereas in the nonunion group, excellent results were obtained in 17 (85%), good in two (10%), and failure in one (5%). Failure in the two patients was due to deep infection requiring prosthesis removal. Other complications were transient ulnar neurapraxia in three, disassembly of the prosthesis in one, patchy heterotopic ossification in two and localised radiolucency around the flanges of the humeral stem in one.
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Affiliation(s)
- Durga P. Baksi
- Department of Orthopaedics, Medical College and Hospital, Kolkata, India
- DA-3, Sector – I, Salt Lake City, Kolkata 700 064 India
| | - Ananda K. Pal
- Department of Orthopaedics, Burdwan Medical College, Burdwan, India
| | - Debadyuti Baksi
- Department of Orthopaedics, K.P.C. Medical College, Jadavpur, Kolkata, India
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228
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Park MJ. Outcomes and Complications of Total Elbow Arthroplasty. Clin Shoulder Elb 2011. [DOI: 10.5397/cise.2011.14.1.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Cho CH, Jung GH, Sin HK, Lee YK, Park JH. Coracoclavicular Ligament Augmentation Using Endobutton for Unstable Distal Clavicle Fractures - Preliminary Report -. Clin Shoulder Elb 2011. [DOI: 10.5397/cise.2011.14.1.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abstract
BACKGROUND A fall on the outstretched arm can result in an elbow fracture. Loss of elbow function is a common problem with these fractures and can have major implications for functional capabilities. It is unknown whether early mobilisation can improve functional outcome without increasing complications. OBJECTIVES To compare the effects (benefits and harms) of early mobilisation versus delayed mobilisation of the elbow after elbow fractures in adults. SEARCH STRATEGY We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (August 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 2), MEDLINE (1950 to August 2010), EMBASE (1980 to August 2010), CINAHL (1982 to June 2010), PEDro (31 May 2010), and ongoing trials registers (April 2010). SELECTION CRITERIA We included randomised and quasi-randomised controlled trials evaluating early mobilisation of the elbow joint after elbow fracture in adults. DATA COLLECTION AND ANALYSIS Two authors independently selected trials, assessed risk of bias and extracted data. There was no pooling of data. MAIN RESULTS We included one trial reporting outcome at follow-up times ranging between two and 47 months for 81 participants with Mason type 1 and 2 radial head fractures. This poorly-reported trial was at particular high risk of detection and reporting biases. The trial found no significant differences between early and delayed mobilisation in the numbers of participants with pain or limitations in their range of elbow motion. All participants were reported as being able to use their arms for full activities of daily living and none had changed their occupation or lifestyle. There was no mention of fracture complications. AUTHORS' CONCLUSIONS There is a lack of robust evidence to inform on the timing of mobilisation, and specifically on the use of early mobilisation, after non-surgical or surgical treatment for adults with elbow fractures.There is a need for high quality, well-reported, adequately powered, randomised controlled trials that compare early versus delayed mobilisation in people with commonly-occurring elbow fractures, treated with or without surgery. Trials should use validated upper limb function scales, and assessment should be both short-term (to monitor recovery and early complications) and long-term (at least one year).
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Affiliation(s)
- Paula Harding
- Department of Physiotherapy, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia, 3004
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Abstract
The Canadian Orthopaedic Trauma Society was started in an endeavour to answer the difficult problem of obtaining enough patients to perform top-quality research into fractures. By maintaining a high standard, including randomised study design, inclusivity, open discussion among surgeons and excellent long-term follow-up, this group has become a leader in the orthopaedic research community. This annotation describes the short history, important components and spirit necessary to build a research community or team which will function well despite the difficult research environment facing individual surgeons.
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Affiliation(s)
- R. Buckley
- University of Calgary, Foothills Medical Center, AC 144A, 1403-29 Street NW, Calgary, Alberta, Canada T2N 2T9
| | - R. Leighton
- QEII Health Science Center, Halifax Infirmary, Room 810, 796 Summer Street, Halifax, Nova Scotia, Canada B3H 3A7
| | - K. Trask
- QEII Health Science Center, Halifax Infirmary, Room 810, 796 Summer Street, Halifax, Nova Scotia, Canada B3H 3A7
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Functional outcome after open reduction internal fixation of intra-articular fractures of the distal humerus in the elderly. J Orthop Trauma 2011; 25:259-65. [PMID: 21464746 DOI: 10.1097/bot.0b013e3181dfd348] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We conducted a study to evaluate the functional outcomes of elderly patients after open reduction internal fixation of intra-articular distal humerus fractures. DESIGN Retrospective clinical and radiographic evaluation. SETTING A Level I trauma and tertiary referral center. PATIENTS/PARTICIPANTS We identified 23 eligible patients aged older than 65 years from the center's orthopaedic trauma registry between 1997 and 2005. Fourteen patients were available for follow-up. We had a mean follow-up of 51 months with a range of 20 to 99 months. INTERVENTION All enrolled patients were acutely treated with open reduction internal fixation of their distal humerus. MAIN OUTCOME MEASUREMENTS All enrolled patients were contacted and evaluated radiographically and with physical examination. Functional outcome was assessed with the Mayo Elbow Performance, Disabilities of Arm and Shoulder and Hand, and Musculoskeletal Functional Assessment functional questionnaires. RESULTS All 14 fractures united. The mean Mayo Elbow Performance score was 83. The mean elbow flexion-extension arc was 20° to 120°. There was no significant loss of forearm pronation-supination (P > 0.05) or grip strength (32.6 versus 34.0 lbs, P > 0.05) compared with the contralateral arm. The mean Disabilities of Arm and Shoulder and Hand score was 37.6. Musculoskeletal Functional Assessment scores demonstrated disability with a mean total score of 33.4 (normative 9.3), hand score of 34.7 (normative 3.7), and self-care score of 31.8 (normative 1.7). One patient required reoperation for a disabling flexion contracture. CONCLUSIONS Intra-articular distal humerus fractures are severely disabling injuries, particularly in the elderly population. Good results can be achieved with stable fixation and fracture union. Despite reasonable range of motion, patient-directed questionnaires revealed persistent pain and functional limitations.
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Abstract
Distal humeral fractures in adults are relatively uncommon injuries that require operative intervention in the majority of cases. Dual plate fixation, with placement of a separate strong plate on each column and orientation of the plates either at 90° or 180° to each other, is indicated for all adult fractures involving both columns of the distal part of the humerus. Acute total elbow arthroplasty is the preferred treatment for elderly patients with a displaced, comminuted, intra-articular distal humeral fracture that is not amenable to stable internal fixation. Displaced coronal shear fractures of the distal humeral articular surface require operative fixation, most typically via a lateral approach.
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Affiliation(s)
- Aaron Nauth
- St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
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234
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Kaiser T, Brunner A, Hohendorff B, Ulmar B, Babst R. Treatment of supra- and intra-articular fractures of the distal humerus with the LCP Distal Humerus Plate: a 2-year follow-up. J Shoulder Elbow Surg 2011; 20:206-12. [PMID: 20951062 DOI: 10.1016/j.jse.2010.06.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 06/03/2010] [Accepted: 06/15/2010] [Indexed: 02/01/2023]
Abstract
BACKGROUND The LCP Distal Humerus Plate (DHP) system represents an angular stable fixation system consisting of 2 anatomically pre-shaped orthogonal plates intended for the treatment of fractures of the distal humerus. The purpose of this retrospective study was to evaluate the clinical and radiologic outcome after a minimum follow-up of 2 years after open reduction and fixation of distal humeral fractures with this device. METHODS Twenty-two consecutive patients with distal humeral fractures were treated with the DHP system between January 2004 and June 2006. Of these, 16 could be clinically and radiologically evaluated after a mean follow-up of 30.5 months. Follow-up included anteroposterior and lateral radiographs; assessment of range of motion; pain according to a VAS; Disabilities of the Arm, Shoulder and Hand score; and Mayo Elbow Performance Score. RESULTS All fractures showed satisfactory articular reduction. One patient showed preoperative sensory ulnar neuropathy, which recovered incompletely, and two patients showed sensory ulnar neuropathy postoperatively, requiring revision surgery in one patient. Mean range of motion was as follows: flexion, 129°; extension, -16°; pronation, 82°; and supination, 71°. The mean visual analog scale score was 1 point; the mean Disabilities of the Arm, Shoulder and Hand score, 23.3 points; and the mean Mayo Elbow Performance Score, 84.7 points. CONCLUSION The DHP system represents a valuable tool to perform internal fixation of complex fractures of the distal humerus. In contrast to conventional plating, we did not observe any case of secondary fracture displacement, even in elderly patients with potentially reduced bone mass. The multiple angular stable point fixation also of small distal fragments seems to be effective in the application of this system.
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Affiliation(s)
- Timm Kaiser
- Department of Trauma Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
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235
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Mehlhoff TL, Bennett JB. Distal humeral fractures: fixation versus arthroplasty. J Shoulder Elbow Surg 2011; 20:S97-106. [PMID: 21281926 DOI: 10.1016/j.jse.2010.11.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 11/12/2010] [Accepted: 11/12/2010] [Indexed: 02/01/2023]
Affiliation(s)
- Thomas L Mehlhoff
- Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX 77030-4509, USA.
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Voloshin I, Schippert DW, Kakar S, Kaye EK, Morrey BF. Complications of total elbow replacement: a systematic review. J Shoulder Elbow Surg 2011; 20:158-68. [PMID: 21134667 DOI: 10.1016/j.jse.2010.08.026] [Citation(s) in RCA: 159] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 08/17/2010] [Accepted: 08/24/2010] [Indexed: 02/01/2023]
Affiliation(s)
- Ilya Voloshin
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA.
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Cross MB, Sherman SL, Kepler CK, Neviaser AS, Weiland AJ. The evolution of elbow arthroplasty: innovative solutions to complex clinical problems. J Bone Joint Surg Am 2010; 92 Suppl 2:98-104. [PMID: 21189246 DOI: 10.2106/jbjs.j.00777] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Davis JM, Robins RJ, Frink SJ, Rispoli DM. Use of a compression tumor implant with total elbow arthroplasty for traumatic distal humeral bone loss in a young woman. J Shoulder Elbow Surg 2010; 19:e24-8. [PMID: 20655761 DOI: 10.1016/j.jse.2010.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 04/02/2010] [Accepted: 04/12/2010] [Indexed: 02/01/2023]
Affiliation(s)
- Jana M Davis
- Department of Orthopaedics, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, TX 78236, USA
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241
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Bioabsorbable interference screw fixation of distal biceps ruptures through a single anterior incision: a single-surgeon case series and review of the literature. Arch Orthop Trauma Surg 2010; 130:875-81. [PMID: 19787360 DOI: 10.1007/s00402-009-0974-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2009] [Indexed: 02/09/2023]
Abstract
INTRODUCTION We present a single-surgeon series of 14 acute ruptured distal biceps tendons repaired using a biotenodesis screw through a single anterior incision. PATIENTS The demographics of this population reveal a typical injury pattern and reflect the preponderance of distal biceps ruptures in the middle aged, active male. Goniometric post-operative assessment of flexion, pronation and supination range demonstrates excellent clinical function in these patients. METHOD Subjective analysis is afforded by DASH and MEPS scoring at the 6-month follow-up. RESULTS The results are discussed in relation to previous studies utilising disparate repair methods. This is the first prospective clinical series to be reported using this combination of fixation and approach. Clinical and patient assessed functions are excellent and complications are minimal. CONCLUSION This is a safe and successful technique for the management of distal biceps tendon ruptures.
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Affiliation(s)
- Matthew L Ramsey
- Shoulder and Elbow Service, Thomas Jefferson University, Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
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The role of locking technology in the upper extremity. J Hand Microsurg 2010; 1:82-91. [PMID: 23129939 DOI: 10.1007/s12593-009-0021-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2009] [Accepted: 07/06/2009] [Indexed: 01/27/2023] Open
Abstract
The technique of locked plating has been a major advance in Orthopaedic fracture surgery and has had an equal impact on the management of upper extremity fractures. The recognition of the role of vascularity and soft tissues in fracture healing was central to the research and development of newer plate designs that left minimal footprints on the surface of the bone. Subsequently, innovative locking technology has improved our ability to manage cases with extensive communition, inadequate bone stock, and peri-articular fractures. This paper will review the role of locking technology in the management of fractures of the upper extremity.
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245
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Abstract
Management of distal humerus fractures continues to challenge orthopaedic surgeons. The unique and complex anatomy of the distal humerus, involving the ulnohumeral and radiocapitellar joints, makes anatomic reduction difficult and hardware placement challenging. However, long-term results of well-performed open reduction and internal fixation demonstrate satisfactory outcomes in most patients. Osteoporosis in the elderly population often leads to severe comminution, which may render open reduction and internal fixation impossible. Total elbow arthroplasty in the elderly has become a viable option, with excellent results in the properly selected patient who understands the lifetime limitations of this option. Distal humeral replacement is a new and potentially exciting option but it is currently not approved by the US Food and Drug Administration and has no long-term follow-up to support its use.
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Nonunion of Humeral Intercondylar Comminuted Fracture Treated with Fibular Graft - A Case Report -. ACTA ACUST UNITED AC 2010. [DOI: 10.12671/jkfs.2010.23.1.118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Work-life imbalance and mental health among male and female employees in Switzerland. Int J Public Health 2009; 54:88-95. [PMID: 19242653 DOI: 10.1007/s00038-009-8031-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES To investigate the prevalence and mental health effects of an unequal work-life balance (WLB) including potential gender differences. METHODS A cross-sectional study based on a representative sample of the Swiss employed population aged 20 to 64 (women: n = 1661; men: n = 1591). RESULTS Based on a single-item measure, more than every seventh employee in Switzerland indicated major difficulties combining work and private life. In certain socio-demographic categories, up to 30% showed such work-life conflict (WLC). For both genders, work-life imbalance turned out to be a risk factor affecting mental health. Employees with self-reported WLC presented a significantly higher relative risk for poor self-rated health (women: aOR = 2.6/men: aOR = 2.0), negative emotions and depression (aOR = 3.0/3.1), low energy and optimism (aOR = 2.1/1.6), fatigue (aOR = 2.4/2.6), and sleep disorders (aOR = 1.8/1.5) compared to employees with no WLC. CONCLUSIONS Internationally, few data on the prevalence of WLC exist. In Switzerland, work-life imbalance is not a marginal phenomenon among the workforce and needs to be addressed as a notable public and mental health issue.
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Ring D. Open reduction and internal fixation of an apparent capitellar fracture using an extended lateral exposure. J Hand Surg Am 2009; 34:739-44. [PMID: 19345881 DOI: 10.1016/j.jhsa.2009.01.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Accepted: 01/25/2009] [Indexed: 02/02/2023]
Abstract
Apparent fractures of the capitellum are often more complex involving the trochlea and the posterior aspect of the lateral column. Many of these fractures can be addressed through an extended lateral exposure, but fixation techniques specific to small, nearly entirely articular fragments will be necessary. When the fracture fragments do not fit, there is usually posterior impaction of the lateral column and sometimes the posterior trochlea.
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Affiliation(s)
- David Ring
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA 02114, USA.
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Grote S, Boecker W, Mutschler W, Schieker M. Current Aspects of Fragility Fracture Repair. Eur J Trauma Emerg Surg 2008; 34:535-41. [DOI: 10.1007/s00068-008-8207-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Accepted: 10/29/2008] [Indexed: 10/21/2022]
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