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McNeil DS, Barton KI, Faber KJ. A case report: instability after distal humerus hemiarthroplasty leading to revision with a total elbow arthroplasty. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:431-435. [PMID: 37588511 PMCID: PMC10426479 DOI: 10.1016/j.xrrt.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
| | - Kristen I. Barton
- Roth|McFarlane Hand and Upper Limb Centre, London, ON, Canada
- Schulich School of Dentistry and Medicine, Western University, London, ON, Canada
- Faculty of Health Sciences, School of Physical Therapy, Western University, London, ON, Canada
| | - Kenneth J. Faber
- Roth|McFarlane Hand and Upper Limb Centre, London, ON, Canada
- Schulich School of Dentistry and Medicine, Western University, London, ON, Canada
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2
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Gabig AM, Malmquist JA, Brady CI, Dutta AK. A Novel Hemiarthroplasty Design for Treatment of Post-traumatic Elbow Ankylosis and Distal Humerus Nonunion: A Case Report. JBJS Case Connect 2022; 12:01709767-202212000-00017. [PMID: 36820842 DOI: 10.2106/jbjs.cc.22.00393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/30/2022] [Indexed: 02/24/2023]
Abstract
CASE A 26 year old man sustained a blast injury to the right elbow, resulting in chronic distal humerus nonunion and post-traumatic ankylosis. After debridement and flap coverage, a custom distal humerus hemiarthroplasty construct with extramedullary orthogonal plating was used. Satisfaction and functional outcomes were maintained through 6 years of follow-up. CONCLUSION This case presents a unique 1-stage surgical solution which demonstrates the potential for uncemented extramedullary hemiarthroplasty fixation with simultaneous compression plate osteosynthesis across a nonunion site. The potential for hemiarthroplasty designs to be linked to orthogonal plates preserves the intramedullary canal for future conversion to total elbow arthroplasty if necessary.
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Affiliation(s)
- Andrew M Gabig
- Joe R and Teresa Lozano Long School of Medicine, San Antonio, Texas
| | | | - Christina I Brady
- Department of Orthopedic Surgery, University of Texas Health San Antonio, San Antonio, Texas
| | - Anil K Dutta
- Department of Orthopedic Surgery, University of Texas Health San Antonio, San Antonio, Texas
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3
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Nielsen AF, Al-Hamdani A, Rasmussen JV, Olsen BS. Elbow hemiarthroplasty vs. open reduction internal fixation for acute Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) type 13C fractures—A systematic review. JSES Int 2022; 6:713-722. [PMID: 36081704 PMCID: PMC9446201 DOI: 10.1016/j.jseint.2022.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Open reduction and internal fixation (ORIF) is the standard treatment for multifragmentary intra-articular distal humeral fractures. Fractures not amenable by ORIF are treated with total elbow arthroplasty (TEA). In recent years, elbow hemiarthroplasty (EHA) has been used as an alternative to TEA, as weight bearing restrictions and risk of component loosening are lower. We systematically reviewed the literature reporting functional outcomes and complication rates after either EHA or ORIF for Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) type 13C fractures. Methods We searched PubMed, Embase, The Cochrane Library, and Scopus. The inclusion criteria were at least 5 patients, aged ≥50 years, AO/OTA type 13C fracture treated with ORIF or EHA, and evaluation with the Mayo Elbow Performance Score. Literature screening and data extraction were conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. The results were synthesized qualitatively using weighted means. No comparative statistical analyses were done. Results We included 27 articles, which included 96 patients treated with EHA and 535 patients treated with ORIF. We identified 1 randomized controlled trial and 26 case series. The weighted mean Mayo Elbow Performance Score was 86.9 (n = 89) in the EHA group and 84.7 (n = 535) in the ORIF group. There were 26 (33%) complications (n = 78) in the EHA group and 103 (38%) complications (n = 270) in the ORIF group. Complication rates were generally high in both groups. Conclusion We found comparable results of EHA and ORIF, which indicate that EHA is a viable treatment option for AO/OTA type 13C fractures not amenable by ORIF. Because of high risk of bias, interpretation of the results should be done with caution.
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4
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Piggott RP, Hennessy O, Aresti NA. Distal humerus hemiarthroplasty for trauma: a systematic review of the outcomes and complications. J Shoulder Elbow Surg 2022; 31:1545-1552. [PMID: 35337953 DOI: 10.1016/j.jse.2022.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/26/2022] [Accepted: 02/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND In patients with distal humerus fractures that are unreconstructible, total elbow arthroplasty is an established alternative to open reduction-internal fixation. Distal humerus hemiarthroplasty is a further alternative to avoid the significant lifestyle limitations associated with total elbow arthroplasty. Distal humerus hemiarthroplasty is an increasingly popular treatment option for unreconstructible distal humeral fractures not amenable to reconstruction. The aim of this systematic review was to assess the literature regarding the functional outcomes and complications of the use of distal humerus hemiarthroplasty for acute trauma. METHODS A systematic review of the PubMed, Embase, and Scopus databases was performed. The search terms included "distal humerus fracture" OR "elbow fracture" AND "hemiarthroplasty" OR "arthroplasty" OR "replacement." Studies were limited to those published in the English language with reported functional outcome measures and complications. Patient demographic characteristics, implant systems, clinical outcomes (range of motion and functional outcome scores), and complications were extracted. RESULTS Thirteen studies with a total of 207 patients met the inclusion criteria. The average age ranged from 44 to 79 years, with the mean length of follow-up ranging from 11 to 82 months postoperatively. A mean range-of-motion arc ≥ 93° was achieved in all studies, with 11 of 13 studies achieving mean functional range of motion ≥ 100°. All studies reported good to excellent mean outcome scores. Heterotopic ossification, ulnar cartilage wear, stiffness, and ulnar neuropathy were the most commonly encountered complications. The reoperation rate and revision rate were 17% and 3%, respectively. CONCLUSIONS Distal humerus hemiarthroplasty is a viable option in the treatment of unreconstructible distal humerus fractures, with good to excellent outcomes expected. Long-term outcome data and the use of distal humerus hemiarthroplasty in younger patients are yet to be fully defined.
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Affiliation(s)
| | - Orla Hennessy
- Midlands Regional Hospital Tullamore, Tullamore, Ireland
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5
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Burden EG, Batten T, Smith C, Evans JP. Hemiarthroplasty or total elbow arthroplasty for unreconstructable distal humeral fractures in patients aged over 65 years : a systematic review and meta-analysis of patient outcomes and complications. Bone Joint J 2022; 104-B:559-566. [PMID: 35491571 DOI: 10.1302/0301-620x.104b5.bjj-2021-1207.r2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Arthroplasty is being increasingly used for the management of distal humeral fractures (DHFs) in elderly patients. Arthroplasty options include total elbow arthroplasty (TEA) and hemiarthroplasty (HA); both have unique complications and there is not yet a consensus on which implant is superior. This systematic review asked: in patients aged over 65 years with unreconstructable DHFs, what differences are there in outcomes, as measured by patient-reported outcome measures (PROMs), range of motion (ROM), and complications, between distal humeral HA and TEA? METHODS A systematic review of the literature was performed via a search of MEDLINE and Embase. Two reviewers extracted data on PROMs, ROM, and complications. PROMs and ROM results were reported descriptively and a meta-analysis of complications was conducted. Quality of methodology was assessed using Wylde's non-summative four-point system. The study was registered with PROSPERO (CRD42021228329). RESULTS A total of 29 studies met the inclusion and exclusion criteria. The mean Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) score was 19.6 (SD 7.5) for HA and 38 (SD 11.9) for TEA and the mean abbreviated version of DASH was 17.2 (SD 13.2) for HA and 24.9 (SD 4.8) for TEA. The Mayo Elbow Performance Score was the most commonly reported PROM across included studies, with a mean of 87 (SD 5.3) in HA and 88.3 (SD 5) in TEA. High complication rates were seen in both HA (22% (95% confidence interval (CI) 5 to 44)) and TEA (21% (95% CI 13 to 30), but no statistically significant difference identified. CONCLUSION This systematic review has indicated PROMs and ROM mostly favouring HA, but with a similarly high complication rate in the two procedures. However, due to the small sample size and heterogeneity between studies, strength of evidence for these findings is low. We propose further research in the form of a national randomized controlled trial. Cite this article: Bone Joint J 2022;104-B(5):559-566.
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Affiliation(s)
| | | | | | - Jonathan P Evans
- Royal Devon and Exeter Foundation Trust, Exeter, UK.,Health Services and Policy Research Unit, University of Exeter Medical School, Exeter, UK
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6
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Celli A, Ricciarelli M, Guerra E, Bonucci P, Ritali A, Cavallo M, Rotini M, Rotini R. Elbow hemiarthroplasty for acute distal humeral fractures and their sequelae: medium- and long-term follow-up of 41 cases. J Shoulder Elbow Surg 2022; 31:1015-1025. [PMID: 35091072 DOI: 10.1016/j.jse.2021.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The earliest distal humeral hemiarthroplasty (or elbow hemiarthroplasty [EHA]) implants, which date back to the late 1940s, were performed in patients with severe elbow joint injuries as an alternative to arthrodesis. After some clinical reports and case studies with a short follow-up, published in the 1990s, a new "anatomically convertible" EHA model was introduced in 2005 and became a common surgical option to treat complex elbow fractures and their sequelae. We describe the mid- and long-term outcomes of EHA performed to treat acute intra-articular fractures or their sequelae. METHODS From 2006 to 2017, 51 patients underwent EHA for acute intra-articular fractures or their sequelae. A total number of 41 patients (80.5% female) with a minimum follow-up of 2 years, 24 with acute lesions and 17 with sequelae, were identified retrospectively. Clinical evaluation was according to the Disabilities of the Arm, Shoulder, and Hand (DASH) score (subjective), and the Oxford Elbow Score (OES) and Mayo Elbow Performance Score (MEPS) (objective). Radiographic follow-up was with standard radiographs. RESULTS Mean follow-up was 92.2 months (range, 24-151). Mean patient age at surgery was 62.8 years (range, 45-81). The mean MEPS was 87.1 points, with excellent results in 26 cases, good results in 9 cases, fair in 2, and poor results in 4. The mean DASH score was 15.9 and the mean OES was 40.5, with satisfactory results in 30 cases. Twenty patients experienced complications and 2 required revision surgery. DISCUSSION EHA is a valuable surgical option in selected patients with comminuted distal humeral joint fractures that cannot be reconstructed with stable fixation and in those with malunion of the articular surface of the humerus. EHA offers potential advantages, especially in active elderly patients and in those aged less than 70 years. It is essential to achieve joint stability, restoring medial and lateral ligament function besides the integrity of the coronoid process. An intact olecranon surface without signs of degenerative changes is also critical for EHA success. CONCLUSION Our mid- and long-term experience with EHA is favorable, with a high proportion of satisfactory results and long survival rates for both lesion types. In selected patients with acute and post-traumatic injuries, EHA is a valuable surgical option.
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Affiliation(s)
- Andrea Celli
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Hesperia Hospital, Modena, Italy.
| | - Marco Ricciarelli
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Enrico Guerra
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Pierluigi Bonucci
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Hesperia Hospital, Modena, Italy
| | - Alice Ritali
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Cavallo
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Rotini
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Hesperia Hospital, Modena, Italy
| | - Roberto Rotini
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Daneshvar P, Gee A, Schemitsch EH, Pike J, Huang A, Jarvie G, Zdero R, Rasoulinejad P. Proximal Ulna Osteotomy for Complex Fractures of the Distal Humerus: A 3-Dimensional Laser Analysis and Comparison With Olecranon Osteotomy. J Hand Surg Am 2022; 47:320-328. [PMID: 35082086 DOI: 10.1016/j.jhsa.2021.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 09/21/2021] [Accepted: 11/12/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The current methods of distal humerus (DH) articular surface visualization only allow a limited view of the joint. This study describes an osteotomy procedure that increases the visualization of and access to the DH articular surface for fixation without compromising ligaments. METHODS Eighteen fresh-frozen human elbows (9 matched pairs) underwent proximal ulna osteotomy (PUO) or transverse olecranon osteotomy (OO) contralaterally. The visualized articular surface of the DH was demarcated, and the surface areas of the DH, capitellum, and trochlea were measured using 3-dimensional scanning. The angular arc of the articular surface of the capitellum and trochlea was measured using a goniometer. RESULTS The 3-dimensional scans showed that 87.6% of the total DH surface area was visualized using PUO versus 65.6% using OO. When the trochlea and capitellum surface areas were separated, 94.0% versus 75.9% of the trochlea and 74.8% versus 44.7% of the capitellum were visualized using PUO and OO, respectively. The goniometric angles demonstrated that 98.2% versus 70.9% of the trochlea and 75.1% versus 43.5% of the capitellum articular surface arc angles were visualized using PUO and OO, respectively. After PUO with further release of the flexor-pronator mass was performed, 100% of the DH articular surface was visualized. CONCLUSIONS Proximal ulnar osteotomy improves the visualization of the DH articular surface. CLINICAL RELEVANCE Proximal ulna osteotomy spares ligaments, avoids osteotomizing the greater sigmoid notch, involves more robust metaphyseal bone for potentially better fixation, and may permit DH arthroplasty without compromising primary ligamentous elbow stabilizers. Further clinical studies are needed to assess the utility of this type of osteotomy.
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Affiliation(s)
- Parham Daneshvar
- Kingston Health Sciences Centre, Kingston General Hospital Site, Kingston, Canada; Department of Surgery, Queen's University, Kingston, Canada; St. Paul's Hospital, University of British Columbia, Vancouver, Canada.
| | - Aaron Gee
- Orthopaedic Biomechanics Lab, Victoria Hospital, London, Canada
| | - Emil H Schemitsch
- Orthopaedic Biomechanics Lab, Victoria Hospital, London, Canada; Department of Surgery, Division of Orthopaedic Surgery, Western University, London, Canada
| | - Jeff Pike
- St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Adrian Huang
- St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Geoff Jarvie
- St. Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Radovan Zdero
- Orthopaedic Biomechanics Lab, Victoria Hospital, London, Canada; Department of Surgery, Division of Orthopaedic Surgery, Western University, London, Canada; Department of Mechanical and Materials Engineering, Western University, London, Canada
| | - Parham Rasoulinejad
- Orthopaedic Biomechanics Lab, Victoria Hospital, London, Canada; Department of Surgery, Division of Orthopaedic Surgery, Western University, London, Canada
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8
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Total elbow arthroplasty in elderly trauma patients: adding a new perspective for functional evaluation. Eur J Trauma Emerg Surg 2022; 48:3941-3947. [PMID: 35246702 PMCID: PMC9532322 DOI: 10.1007/s00068-022-01921-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 12/30/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE Total elbow arthroplasty (TEA) has evolved over the last years, with satisfactory early results, mainly not only in degenerative arthritis, but also increasingly after trauma. Outcome studies in recently published papers are mainly based on the range of motion (ROM), complication rate as well as patient-reported outcome scales and questionnaires. The purpose of this study was to add a new perspective with the "Purdue Pegboard" skill tests in a homogenous set of elderly trauma patients to contribute to a more precise objective outcome measurement in this specific population. METHODS A retrospective review was performed on a consecutive cohort of all patients with age above 60 years that received TEA after trauma. Data from follow-up examinations over a standardized time-schedule within 2 years after TEA were included. Mayo Elbow Performance Score (MEPS), "Disability of Arm, Shoulder and Hand" (DASH) Questionnaire, ROM as well as test-scores using the Pegboard test were evaluated. RESULTS Mean age was 76.0 years ± 10.3. Indications for TEA were posttraumatic arthrosis in 68.8% (n = 11) and extensive fractures that could not be reconstructed surgically in 31.3% (n = 5). The mean score of MEPS was 82.81 ± 16.63 and 29.18 ± 12.01 in the DASH. ROM presented with a mean of 109.7° ± 15.4. Patients demonstrated good, but marginally reduced test scores in the Pegboard skill tests in comparison with the healthy reference population. No relevant differences between the arm with and the arm without TEA (0.3 ± 3.6; p = 0.715) were noted after 2 years. CONCLUSION In the elderly trauma patient with complex fractures of the elbow, TEA is a good alternative to joint reconstruction using various osteosynthesis techniques. TEA is able to avoid revision surgery after open reduction and internal fixation of complex fractures. In cases of failed reconstruction, it is also a viable secondary procedure in posttraumatic arthrosis. Good outcomes in functionality and dexterity can be achieved. Skill tests like the Purdue Pegboard could add a valuable perspective in assessing functional outcomes after TEA.
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9
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Jenkins CW, Edwards GAD, Chalk N, McCann PA, Amirfeyz R. Does preservation of columns affect the medium-term outcome in distal humerus hemiarthroplasty for acute unreconstructable fractures? Shoulder Elbow 2022; 14:85-94. [PMID: 35154409 PMCID: PMC8832714 DOI: 10.1177/1758573220977768] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/09/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND We assessed distal humeral column preservation effects on clinical, radiographic and patient reported outcomes following distal humerus hemiarthroplasty for acute unreconstructable fractures. METHODS Thirty-seven consecutive patients (mean age, 75; range, 29-93 years) with an average follow-up of 61 months (range, 24-105 months) after distal humerus hemiarthroplasty using a triceps preserving approach were studied. QuickDASH and Oxford Elbow Score assessed patient reported outcomes. Clinical and radiographic assessments comprised range of motion, grip strength, instability, implant loosening, chondral wear, heterotopic ossification and condylar union. RESULTS Average QuickDASH was 14.9 (range, 0-63) and Oxford Elbow Score 40.35 (range, 25-48). Mean flexion arc was 108°, extension deficit 17° and pronosupination arc 155°. Average operative sided grip strength was 31.05 kg versus 31.13 kg contralaterally. Column preservation had no statistically significant effect on QuickDASH (p = 0.75), Oxford Elbow Score (p = 0.78), flexion-extension (p = 0.87), pronosupination (p = 0.78) or grip strength (p = 0.87). No progressive radiographic loosening or symptomatic chondral wear occurred. All fixed columns united. Three cases of immediate post-operative laxity fully resolved on elbow mobilisation. Four post-operative complications required further surgery: one ulnar neuropathy, one heterotopic ossification, one wound breakdown and one traumatic dislocation. CONCLUSION Medium-term outcome of distal humerus hemiarthroplasty for acute unreconstructable distal humeral fractures is reliable irrespective of condylar preservation.
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Affiliation(s)
| | | | | | | | - Rouin Amirfeyz
- Rouin Amirfeyz, Department of Orthopaedic Surgery, Bristol Royal Infirmary, Upper Maudlin Street, Bristol BS2 8HW, UK.
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10
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Wilfred AM, Akhter S, Horner NS, Aljedani A, Khan M, Alolabi B. Outcomes and complications of distal humeral hemiarthroplasty for distal humeral fractures - A systematic review. Shoulder Elbow 2022; 14:65-74. [PMID: 35154405 PMCID: PMC8832700 DOI: 10.1177/17585732211023100] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/07/2021] [Accepted: 05/15/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Distal humeral hemiarthroplasty has been performed for a variety of indications with the most common being management of distal humeral fractures. This systematic review evaluates the outcomes and complications of distal humeral hemiarthroplasty for this pathology. METHODS We searched PubMed, EMBASE, and MEDLINE for studies reporting indications and outcomes of patients undergoing distal humeral hemiarthroplasty. Study screening, risk of bias assessment, and data extraction were performed. Summery statistics were provided. RESULTS We included 11 studies (N = 163) in this review. In all studies, the indication for distal humeral hemiarthroplasty was the presence of an intraarticular, comminuted, unreconstructable fracture. The mean post-operative MEPS, FullDASH, and QuickDASH (SD) scores were 83.6 (6.1) points, 25.4 (10.3), and 15.7 (7.4) points, respectively. The mean post-operative range of motion (SD) was 106° (11°) in the flexion and extension arc and 153° (19°) in the protonation and supination arc. The overall rate of adverse events and complication was 63%. The rate for major complications was 11%. The mean total revision rate was 4% (0% to 15) and total re-operation rate was 29% (0% to 88%). CONCLUSION Distal humeral hemiarthroplasty is a suitable option for unreconstructable distal humeral fractures and offers good functional outcomes with acceptable complication rates.
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Affiliation(s)
- Ann M Wilfred
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Shakib Akhter
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada,Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Nolan S Horner
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Ahmed Aljedani
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada,Moin Khan, McMaster University St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, ON, Canada L8N 4A6.
| | - Bashar Alolabi
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
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11
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Russo R, Guastafierro A, Della Rotonda G, Viglione S, Ciccarelli M, Fiorentino F, Minopoli P, Mortellaro M, Pietroluongo LR, Langella F. Osteochondral allograft transplantation for complex distal humeral fractures assisted by 3D computer planning and printing technology: technical note. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1443-1450. [PMID: 34524509 DOI: 10.1007/s00590-021-03118-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/06/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The surgical treatment of comminuted distal humeral articular fractures (DHF) is challenging and is jeopardized by the high rate of complications. The study aims to describe the application of osteochondral allograft (OCA) transplantation for the treatment of complex DHF assisted with a 3D printed specific instrumentation. METHODS Retrospective study. Inclusion criteria were the presence of an articular multi-fragmented DHF treated with frozen OCA. Clinical, self-reported and radiographic outcomes were collected every 6 months. CT were performed at 2 years FU. RESULTS Four patients were included. At a mean follow-up of 37.3 months (24-49) MEPS, DASH and VAS were 90 (80-100), 11.8 (0-25) and 1 (0-3) points, respectively. Not significant complication or reoperation was recorded. Graft healing was observed in 3 cases. In all cases, we observed arthritic progression after 2 years of follow-up. CONCLUSION OCA transplantation can be considered a reliable and safe procedure in patients affected by a complex DHF. LEVEL OF EVIDENCE Level V. Technical Notes.
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Affiliation(s)
- Raffaele Russo
- Second Orthopaedic and Traumatology Unit, Pineta Grande Hospital, Caserta, Italy
| | - Antonio Guastafierro
- Second Orthopaedic and Traumatology Unit, Pineta Grande Hospital, Caserta, Italy
| | | | - Stefano Viglione
- Second Orthopaedic and Traumatology Unit, Pineta Grande Hospital, Caserta, Italy
| | - Michele Ciccarelli
- Second Orthopaedic and Traumatology Unit, Pineta Grande Hospital, Caserta, Italy
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12
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Ricón-Recarey FJ, Lajara-Marco F, Fuentes-Díaz A, Correoso-Castellanos S. Results of the distal humeral hemiarthroplasty Latitude in distal humeral unreconstructable fractures treatment in patients older than 65 years old. ACTA ACUST UNITED AC 2021. [PMID: 34112447 DOI: 10.1016/j.recote.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM The aim of this study is evaluate clinical and radiographic outcomes of Latitude elbow hemiarthroplasty in the treatment of articular distal humerus multifragmentary fractures in patients older than 65 years. MATERIAL AND METHODS We included those patients older than 65 years who sustained an unreconstructable articular distal humeres fracture and it was replace with a Latitude hemiarthroplasty. We excluded those with a minimum follow up less than 2 years. The clinical outcomes were assessed with Mayo Elbow Performance Score (MEPS). Range of motion, pain, complications and elbow radiological assessments were recorded at the final follow up. RESULTS We have found that after a mean follow-up of 5 years, the five patients included in the study have mild pain in the elbow. They have recovered a median flexion arch of 100°, with a 10° extension lag. The MEPS was considered as good in all the cases. There were not any instability or prosthesis loosening, but two patients developed a moderate proximal cubitus wear. CONCLUSION Latitude elbow arthroplasty is an option in the distal articular humerus multifragmentary fractures treatment in osteoporotic and ageing patients with satisfactory results as long as the elbow ligamentous stability can be restored.
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Affiliation(s)
- F J Ricón-Recarey
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Vega Baja de Orihuela, Alicante, Spain.
| | - F Lajara-Marco
- Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Reina Sofía de Murcia, Murcia, Spain
| | - A Fuentes-Díaz
- Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Morales Meseguer de Murcia, Murcia, Spain
| | - S Correoso-Castellanos
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Vega Baja de Orihuela, Alicante, Spain
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Jukes CP, Dirckx M, Phadnis J. Current concepts in distal humeral hemiarthroplasty. J Clin Orthop Trauma 2021; 19:224-230. [PMID: 34150495 PMCID: PMC8190472 DOI: 10.1016/j.jcot.2021.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022] Open
Abstract
Multi-fragmentary intra-articular fractures of the distal humerus remain a challenge for both patients and surgeons. Open Reduction internal fixation remains the gold standard, however in older patients with comminuted fractures this might not be feasible. There is a growing interest in hemi-arthroplasty as a solution for these cases. However the current experience and follow-up in limited. This review article intends to describe the current concepts in elbow hemiarthroplasty in dept. we will discuss the historical use of these implants, as well as the intricacies of more modern devices. Next we will elaborate an surgical planning, approach, and technical pearls. We will lay out a rehab protocol used by the senior author, and with some considerations for the future.
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Resultados de la hemiartroplastía de húmero distal Latitude en el tratamiento de las fracturas articulares de húmero distal irreparables en mayores de 65 años. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [DOI: 10.1016/j.recot.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Rotini R, Ricciarelli M, Guerra E, Marinelli A, Celli A. Elbow hemiarthroplasty in distal humeral fractures: Indication, surgical technique and results. Injury 2020; 54 Suppl 1:S36-S45. [PMID: 33223259 DOI: 10.1016/j.injury.2020.11.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/05/2020] [Accepted: 11/08/2020] [Indexed: 02/02/2023]
Abstract
The surgical management of distal humerus fractures in adults generally consists in open reduction internal fixation (ORIF) or total elbow arthroplasty (TEA). Hemi humeral hemiarthroplasty (EHA) is a treatment option for unreconstructable intra-articular distal humerus fractures. It is a reasonable option in patients over the fifth decade and its potential advantages are to eliminate the complications related to the ulnar component such as wear of the hinge (busching wear) or the aspetic loosening of the ulnar component. The potential disadvantages are the risk of instability with the possibility of a wear and progressive joint osteoarthrosis. The aims of this manuscript are to evaluate the indications in which we used the EHA, analyzing the correct surgical technique and describe the outcomes in medium and long-term follow-ups. Between 2006 and 2019, we performed 51 EHAs at the Hesperia Hospital in Modena and at the Rizzoli Orthopedic Institute. Taking into consideration only the cases of acute fractures, 27 patients (27 elbows) with a minimum follow-up of 12 months were identified. The patient's mean age at the time of surgery was 64 years old (range from 45 to 78 years old) and they were 78% female (21 out of 27). The Latitude Tornier implant was used in all the patients of our group. The mean MEPS was 89.3 points (from 50 to 100 pts) with excellent results in 19 patients, good in 5, one fair and 2 poor;the mean DASH was 12.6 (from 3.3 to 45.8); the mean OES was 42.3 (from 22 to 47). Complications, were found in 12 patients and any patients required a TEA conversion. Distal humerus hemiarthroplasty from our experience is a good option for the surgical management of unrecostructible distal humeral fractures in selected patients. It is important to perform a precise surgical technique; preserve the triceps insertion, preserve or repair the collateral ligaments, fix the condylar bones implant the prosthesis at the correct size, depth and rotation. The majority of the complication that we observed are related to the stiffness and no to the progressive degenerative changes of the articular surface.
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Affiliation(s)
- Roberto Rotini
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, Bologna, Italy.
| | - Marco Ricciarelli
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, Bologna, Italy
| | - Enrico Guerra
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, Bologna, Italy
| | - Alessandro Marinelli
- Shoulder and Elbow Unit, IRCCS Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, Bologna, Italy
| | - Andrea Celli
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Hesperia Hospital, Modena, Italy
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Abstract
Distal humerus hemiarthroplasty is a good surgical option for nonreconstructable intraarticular distal humerus fractures in selected lower-demand patients. The lifetime activity restrictions have not been determined, but are likely less than a total elbow arthroplasty. From a technical standpoint, distal humeral prostheses should be implanted at the correct depth and rotation. The collateral ligaments, condyles, and epicondyles should be preserved and/or repaired to maintain joint stability. Short- to midterm retrospective studies have shown promising results.
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Cottias P, Leclerc P, Zaoui A, Abouchaaya AM, Khallouk R, Anract P. Digastric olecranon osteotomy a new approach to the elbow: retrospective study of 24 Coonrad–Morrey® total elbow arthroplasty at 30-month follow-up. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:485-491. [DOI: 10.1007/s00590-019-02590-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 11/02/2019] [Indexed: 11/25/2022]
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Outcomes After Hemiarthroplasty of the Elbow for the Management of Posttraumatic Arthritis: Minimum 2-Year Follow-up. J Am Acad Orthop Surg 2019; 27:727-735. [PMID: 30789379 DOI: 10.5435/jaaos-d-18-00055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Hemiarthroplasty (HA) of the elbow represents an alternative to total elbow arthroplasty (TEA) without the associated activity restrictions. This study reviews our experience with distal humerus HA with minimum 2-year follow-up. METHODS Between 2002 and 2012, 16 elbows underwent HA for posttraumatic arthritis of the elbow. Patients were followed for a minimum of 2 years or until revision surgery. Outcome measures included pre- and postoperative Mayo Elbow Performance Scores (MEPSs), complications, and revisions. RESULTS Mean age at arthroplasty was 45 years, and follow-up averaged 51 months. All patients had previously undergone one or more surgical procedures at the elbow (average of 1.5 procedures). At follow-up, five had undergone additional surgery; two were revised to TEA. In surviving implants, the range of motion at follow-up was markedly improved from preoperative motion. The MEPS for the remaining HA included five excellent results, three good results, five fair results, and one poor result. DISCUSSION Elbow HA is an option for young or active patients with end-stage elbow posttraumatic arthritis who are unwilling to accept activity limitations. However, high rates of revision surgery and revision to TEA occur after HA for posttraumatic osteoarthritis of the elbow. Only 57% of patients with surviving implants had a good to excellent MEPS, although improvement in the range of motion was predictable.
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Goodman AD, Johnson JP, Kleiner JE, Gil JA, Daniels AH. The expanding use of total elbow arthroplasty for distal humerus fractures: a retrospective database analysis of 56,379 inpatients from 2002-2014. PHYSICIAN SPORTSMED 2018; 46:492-498. [PMID: 30073892 DOI: 10.1080/00913847.2018.1508315] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Distal humerus fractures are challenging to treat, with significant morbidity. Precontoured distal humerus locking plates and total elbow arthroplasty implants have become available in the past 15 years, potentially offering the promise of improved outcomes. However, national data regarding the usage of and in-hospital complications associated with these implants is scarce. Therefore, we aimed to determine if the incidence of inpatients with distal humerus fractures treated with arthroplasty or open reduction and internal fixation (ORIF) changed over time. Secondarily, we sought to determine what demographic factors were associated with arthroplasty versus fixation and compare inpatient outcomes. METHODS Inpatients over 50 years old with operatively treated closed distal humerus fractures were identified between 2002 and 2014 in the Nationwide Inpatient Sample, a nationally representative, all-payer database. Patient demographic factors were associated with treatment type. Outcomes examined included complications, mortality, length-of-stay, and charges; multivariable logistic regression compared associations with treatment. RESULTS Of 56,379 inpatients undergoing surgery, the proportion undergoing arthroplasty rose 2.3-fold from 4.8% to 10.9% from 2002 to 2014 (OR 1.039/year [95% CI [1.016-1.062]). Annual patient volume remained similar. Arthroplasty patients were older than those undergoing fixation (75.5 vs. 71.0 years, p < 0.001), more likely to be female (83.1% vs. 75.4%, p < 0.001), and less likely to be treated at a rural hospital (OR 0.601, 95% CI 0.445-0.812, p < 0.001). There was no significant difference in comorbidities. Arthroplasty patients had similar inpatient medical complication (7.1% vs. 7.8%, OR 0.998, p = 0.988) and mortality rates (0.38% vs. 0.94%, OR 0.426, p = 0.102), a decreased length of stay (by 0.3 days, p = 0.032), but increased hospital charges (by $12,033, p < 0.001). CONCLUSIONS For inpatients over 50 years old with operatively-treated distal humerus fractures, use of elbow arthroplasty has expanded, albeit with increased cost. Further studies may help to delineate the long-term costs and benefits, as well as which patients may benefit from each type of implant. LEVEL OF EVIDENCE Level III, Therapeutic Study.
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Affiliation(s)
- Avi D Goodman
- a Brown University/Rhode Island Hospital - Orthopaedics , Providence , RI , USA
| | - Joseph P Johnson
- a Brown University/Rhode Island Hospital - Orthopaedics , Providence , RI , USA
| | - Justin E Kleiner
- b Warren Alpert Medical School of Brown University , Providence , RI , USA
| | - Joseph A Gil
- a Brown University/Rhode Island Hospital - Orthopaedics , Providence , RI , USA
| | - Alan H Daniels
- a Brown University/Rhode Island Hospital - Orthopaedics , Providence , RI , USA
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Kwak JM, Kholinne E, Sun Y, Lee GB, Koh KH, Chun JM, Jeon IH. Hemiarthroplasty for Distal Humerus Fracture: A Systematic Review and Meta-analysis for Functional Outcome. Clin Shoulder Elb 2018; 21:120-126. [PMID: 33330164 PMCID: PMC7726389 DOI: 10.5397/cise.2018.21.3.120] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 07/08/2018] [Indexed: 11/30/2022] Open
Abstract
Background Treatment of distal humerus fractures in osteoporotic elderly patients is often challenging. For non-reconstructible fractures with open reduction and internal fixation, total elbow arthroplasty (TEA) is an acceptable alternative. However, the relatively high complication rates and lifelong activity restrictions make TEA less ideal for elderly or low-demand patients. Efforts to identify or develop alternate procedures that benefit relatively young, high-demand patients have resulted in increased interest in hemiarthroplasty. This systematic review reports the clinical outcomes of hemiarthroplasty for distal humeral fractures. Methods We systematically reviewed the databases of PubMed, Ovid MEDLINE, and Cochrane Library. All English-language studies published before June 2017 were considered for possible inclusion. Search terms included ‘distal humerus fracture’ and ‘hemiarthroplasty’. Studies reporting outcomes (and a minimum of 1 year clinical follow-up) in human subjects after hemiarthroplasty (Latitude system) for distal humeral fractures were assessed for inclusion. Patient demographics, clinical and radiographic outcomes, and complications were recorded, and homogenous outcome measures were analyzed. Results Nine studies with a total of 115 patients met the inclusion criteria. Among the included studies, the weighted mean follow-up time was 35.4 months. Furthermore, the weighted mean of the postoperative range of motion (107.6° flexion-extension, 157.5° for pronation-supination) and functional outcomes (Mayo elbow performance scores: 85.8, Disabilities of the Arm, Shoulder and Hand score: 19.6) were within the acceptable range. Conclusions Our study indicates that hemiarthroplasty is a viable option for comminuted distal humerus fracture. Satisfactory functional outcomes were observed in most patients.
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Affiliation(s)
- Jae-Man Kwak
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Erica Kholinne
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia
| | - Yucheng Sun
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gwan Bum Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyoung Hwan Koh
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Myeung Chun
- Department of Orthopaedic Surgery, Armed Forces Capital Hospital, Seongnam, Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Willing R. Design optimisation improves the performance of custom distal humeral hemiarthroplasty implants. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING-IMAGING AND VISUALIZATION 2018. [DOI: 10.1080/21681163.2018.1446054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Ryan Willing
- Department of Mechanical Engineering, Thomas J. Watson School of Engineering and Applied Science, State University of New York, Binghamton, NY, USA
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Ul Islam S, Glover AW, Waseem M. Challenges and Solutions in Management of Distal Humerus Fractures. Open Orthop J 2017; 11:1292-1307. [PMID: 29290867 PMCID: PMC5721336 DOI: 10.2174/1874325001711011292] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 10/02/2017] [Accepted: 10/05/2017] [Indexed: 11/22/2022] Open
Abstract
Background Management of distal humerus fractures remains a challenge for trauma surgeons and advancements in treatment options continue to be made to achieve the best results for patients presenting with these complex fractures. Our aim in this article is to provide the surgeons with a detailed review of current literature to help them make an evidence based decision when faced with managing such complex injuries in their surgical practice. Methods This is a comprehensive review of the current literature that details various aspects of distal distal humerus fractures such as classification, surgical anatomy, surgical approaches, treatment options, choices of devices, outcomes and complications. Results With the advancements in techniques and equipment, there has been improvement in patients' outcomes following surgical management of these fractures and a large proportion of these patients are able to achieve pre-injury level of function. The contoured locking plates have enabled successful fixation of many of these fractures that were previously considered unfixable. For those not amenable to surgical fixation, total elbow arthroplasty and elbow hemiarthroplasty are considered as good alternatives. Conclusion Since the days where the 'bag of bones' technique was the preferred method of treating these complex injuries, techniques and outcomes have advanced greatly. However, they still present a significant technical challenge and need meticulous technique and experience to achieve optimal results.
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Affiliation(s)
- Saif Ul Islam
- Macclesfield District General Hospital, Cheshire, United Kingdom
| | | | - Mohammad Waseem
- Macclesfield District General Hospital, Cheshire, United Kingdom
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An In Vitro Study of the Role of Implant Positioning on Ulnohumeral Articular Contact in Distal Humeral Hemiarthroplasty. J Hand Surg Am 2017; 42:602-609. [PMID: 28450102 DOI: 10.1016/j.jhsa.2017.03.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 03/25/2017] [Accepted: 03/31/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the effect of implant positioning on ulnohumeral contact using patient-specific distal humeral (DH) implants. METHODS Seven reverse-engineered DH implants were manufactured based on computed tomography scans of their osseous geometry. Native ulnae were paired with corresponding native humeri and custom DH implants in a loading apparatus. The ulna was set at 90° of flexion and the humeral component (either native bone or reverse-engineered implant) was positioned from 5° varus to 5° valgus in 2.5° increments under a 100-N compressive load. Contact with the ulna was measured with both the native distal humerus and the reverse-engineered DH implant at all varus-valgus (VV) angles, using a joint casting method. Contact patches were digitized and analyzed in 4 ulnar quadrants. Output variables were contact area and contact pattern. RESULTS Mean contact area of the native articulation was significantly greater than with the distal humeral hemiarthroplasty (DHH) implants across all VV positions. Within the native condition, contact area did not significantly change owing to VV angulation. Within the DHH condition, contact area also did not significantly change owing to VV angulation. Conversely, in the DHH condition, contact pattern did significantly change. Medial ulnar contact pattern was significantly affected by VV angulation. Lateral ulnar contact was variably affected, but generally decreased as well. CONCLUSIONS Ulnar contact patterns were changed as a result of VV implant positioning using reverse-engineered DH implants, most notably on the medial aspect of the joint. Implant positioning plays a crucial role in producing contact patterns more like those observed in the native joint. CLINICAL RELEVANCE Recent clinical evidence reports nonsymmetrical ulnar wear after DHH. This work suggests that implant positioning is likely a contributing factor and that more exact implant positioning may lead to better clinical outcomes.
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Giannicola G, Spinello P, Scacchi M, Gumina S. Cartilage thickness of distal humerus and its relationships with bone dimensions: magnetic resonance imaging bilateral study in healthy elbows. J Shoulder Elbow Surg 2017; 26:e128-e136. [PMID: 28131685 DOI: 10.1016/j.jse.2016.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 10/20/2016] [Accepted: 10/26/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Little is known about the cartilage thickness of the distal humerus and how it affects the shape of the articular surface. Our aims were to assess cartilage thickness and to determine the extent to which it affects the true profile of the distal humerus. METHODS We assessed 78 healthy elbows (39 subjects, 19 women and 20 men) with a mean age of 28 years (range, 21-32 years). Cartilage thickness was measured by use of high-definition magnetic resonance imaging scans at 19 different points of the articular surface, 13 on the trochlea and 6 on the capitellum, on the axial and coronal views. Bone diameters at the medial and lateral trochlear ridges, trochlear groove, and capitellum, as well as the articular surface width, were measured. Subject height was used as an indirect measurement of humerus length. Pearson correlation coefficients and the Student t test were used. RESULTS Cartilage thickness showed a significant variation (range, 0.4-1.8 mm) independent of sex and side. It appeared thinner at the medial and lateral edges, whereas it increased at the level of the trochleocapitellar and trochlear grooves, the lateral trochlear ridges, and the center of the capitellum. The mean bone diameters of the medial ridge, lateral ridge, trochlear groove, and capitellum measured 25.1 mm, 21 mm, 16.9 mm, and 19.6 mm, respectively. The mean width of the articular surface was 42.9 mm (range, 35.8-50.2 mm). No significant correlation was found between cartilage thickness and bone dimensions. CONCLUSION Cartilage thickness is not uniform and modifies the morphologic shape and diameters of the humeral articular surface. These findings may be relevant to anatomic prosthesis design.
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Affiliation(s)
- Giuseppe Giannicola
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome- Policlinico Umberto I, Rome, Italy.
| | - Paolo Spinello
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome- Policlinico Umberto I, Rome, Italy
| | - Marco Scacchi
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome- Policlinico Umberto I, Rome, Italy
| | - Stefano Gumina
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics Sciences, "Sapienza" University of Rome- Policlinico Umberto I, Rome, Italy
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Abstract
Distal humeral replacement and the total elbow are two commonly-used arthroplasties Each prosthesis has evolving indications and surgical techniques Recent changes in device design and implantation methods are due to biomechanical and clinical outcome-based research New prostheses and methods provide: better elbow kinematics, more durable bearings and longer-lasting joint replacement potential
Cite this article: EFORT Open Rev 2017;2:83-88. DOI: 10.1302/2058-5241.2.160064
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Affiliation(s)
| | - Akin Cil
- University of Missouri-Kansas City, Kansas City, USA
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Schultzel M, Scheidt K, Klein CC, Narvy SJ, Lee BK, Itamura JM. Hemiarthroplasty for the treatment of distal humeral fractures: midterm clinical results. J Shoulder Elbow Surg 2017; 26:389-393. [PMID: 27914843 DOI: 10.1016/j.jse.2016.09.057] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 09/13/2016] [Accepted: 09/27/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total elbow arthroplasty is a treatment for unreconstructable distal humeral fractures; however, longevity of the implant remains a concern in younger, more active patients. Distal humeral hemiarthroplasty (DHH) offers an alternative with multiple advantages. METHODS This is a retrospective study of 10 patients who underwent DHH for distal humeral fractures during a 4-year period (2008-2012) by a single surgeon. Patients underwent testing of range of motion, Mayo Elbow Performance Score, Disabilities of Arm, Shoulder and Hand, visual analog scale, Single Assessment Numeric Evaluation, and American Shoulder and Elbow Surgeons scores. Average patent age at surgery was 71.9 years (range, 56-81 years); average follow-up was 73.2 months (range, 36-96 months). RESULTS Patients maintained improvements in Mayo Elbow Performance Scores (mean, 89.23; range, 75-100) and Disabilities of Arm, Shoulder and Hand scores (mean, 33.71; range 11.2-55.1), along with no significant decrease in range of motion compared with 1 year after surgery. Mean visual analog scale was 2.43 (range, 0-5), Single Assessment Numeric Evaluation was 74.14 (range, 50-100), and American Shoulder and Elbow Surgeons score was 72.14 (range, 48.33-100). Participants had an average flexion of 128.7° (range, 95°-142°), extension deficit of 27.1° (range, 0°-45°), supination of 79.1° (range, 45°-90°), and pronation of 73.3° (range, 50°-90°). No heterotopic ossification, elbow dislocations, or subluxations were observed. Complications included 1 fracture and 1 complaint of prominent hardware. Two patients died, and 1 patient was lost to follow-up. CONCLUSION This midterm review suggests that DHH may be an effective treatment for certain distal humeral fractures. The data suggest that elbow range of motion and functional use are maintained from comparison with short-term studies. Additional studies must be conducted to further define the role of DHH for complex fractures of the distal humerus.
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Affiliation(s)
- Mark Schultzel
- Kerlan Jobe Orthopaedic Clinic at White Memorial Medical Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Karl Scheidt
- Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA
| | - Christopher C Klein
- Kerlan Jobe Orthopaedic Clinic at White Memorial Medical Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Steven J Narvy
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Brian K Lee
- Kerlan Jobe Orthopaedic Clinic at White Memorial Medical Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - John M Itamura
- Kerlan Jobe Orthopaedic Clinic at White Memorial Medical Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Rangarajan R, Papandrea RF, Cil A. Distal Humeral Hemiarthroplasty Versus Total Elbow Arthroplasty for Acute Distal Humeral Fractures. Orthopedics 2017; 40:13-23. [PMID: 28375524 DOI: 10.3928/01477447-20161227-02] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
For acute distal humeral fractures not amenable to open reduction and internal fixation, total elbow arthroplasty has become an established alternative. However, lifelong activity restrictions designed to prevent early mechanical failure make this a poor option for some patients. This has led to a renewed interest in distal humeral hemiarthroplasty. Using modern implants and techniques, distal humeral hemiarthroplasty has shown outcomes comparable to those of total elbow arthroplasty at short- to mid-term follow-up, with an overall higher but different complication rate. Long-term data are needed, but the available literature suggests that distal humeral hemiarthroplasty be considered as another option on the treatment spectrum in select patient populations. [Orthopedics. 2017; 40(1):13-23.].
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Smith GCS, Bayne G, Page R, Hughes JS. The clinical outcome and activity levels of patients under 55 years treated with distal humeral hemiarthroplasty for distal humeral fractures: minimum 2-year follow-up. Shoulder Elbow 2016; 8:264-70. [PMID: 27660659 PMCID: PMC5023057 DOI: 10.1177/1758573216660958] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/31/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of the present study was to describe the clinical outcomes and activity levels of young patients after distal humeral hemiarthroplasty (DHH). METHODS Six patients under 55 years (mean 44 years; range 29 years to 52 years) treated with DHH at a mean postoperative time of 81 months (range 24 months to 133 months) were studied retrospectively. Two other patients had been revised for aseptic loosening and were excluded. RESULTS The mean Mayo Elbow Score (MEPS) (88), Subjective Elbow Value (SEV) (89), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) (12) and American Shoulder and Elbow Surgeons (ASES) elbow pain (6), function (23) and satisfaction scores (9) were satisfactory. The mean University of California, Los Angeles (UCLA) activity score was 7.2. CONCLUSIONS Although only rarely indicated, DHH has satisfactory clinical outcomes in young patients and allows a higher level of function than is generally advised after total elbow arthroplasty.
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Affiliation(s)
- Geoffrey C. S. Smith
- St George Hospital, Gray Street, Kogarah, NSW, Australia,Geoffrey C. S. Smith, St George Hospital, Gray Street, Kogarah, NSW 2217, Australia.
| | - Grant Bayne
- Barwon Orthopaedic Research Unit, The Geelong Hospital, Barwon Health, Geelong, VIC, Australia
| | - Richard Page
- Barwon Orthopaedic Research Unit, The Geelong Hospital, Barwon Health, Geelong, VIC, Australia
| | - Jeff S. Hughes
- Orthopaedic and Arthritis Specialist Centre, The Gallery, Chatswood, NSW, Australia
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Phadnis J, Watts AC, Bain GI. Elbow hemiarthroplasty for the management of distal humeral fractures: current technique, indications and results. Shoulder Elbow 2016; 8:171-83. [PMID: 27583016 PMCID: PMC4950283 DOI: 10.1177/1758573216640210] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/25/2016] [Indexed: 11/16/2022]
Abstract
There has been a growing recent interest in the use of elbow hemiarthroplasty for the treatment of distal humeral trauma in select patients. However, the current available evidence regarding outcome after elbow hemiarthroplasty is limited to case series and biomechanical data. Consequently, the procedure remains unfamiliar to many surgeons. The aim of the present review is to outline the evidence regarding elbow hemiarthroplasty and to use this, along with the author's experience, to better describe the indications, surgical technique and outcomes after this procedure.
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Affiliation(s)
- Joideep Phadnis
- Department of Orthopaedics, Brighton and Sussex University Hospitals, Brighton, UK,Joideep Phadnis, 70 Nevill Avenue, Hove, East Sussex BN3 7NA, UK. Tel: +44 (0)7496853014.
| | - Adam C Watts
- Upper Limb Unit, Wrightington Hospital, Wigan, UK
| | - Gregory I Bain
- Department of Orthopaedics, Flinders University, Bedford Park, SA, South Australia
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Abstract
Posttraumatic elbow stiffness is a disabling condition that remains challenging to treat despite improvement of our understanding of the pathogenesis of posttraumatic contractures and new treatment regimens. This review provides an update and overview of the etiology of posttraumatic elbow stiffness, its classification, evaluation, nonoperative and operative treatment, and postoperative management.
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31
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Karrasch CK, Smith EJ, Armstrong AD. Distal humerus articular malunion after an open reduction-internal fixation of a capitellum-trochlea shear fracture: a case report. J Shoulder Elbow Surg 2016; 25:e55-60. [PMID: 26927435 DOI: 10.1016/j.jse.2015.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 12/07/2015] [Accepted: 12/14/2015] [Indexed: 02/01/2023]
Affiliation(s)
- Chris K Karrasch
- Department of Orthopeadics, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Evan J Smith
- Department of Orthopaedics, George Washington University, Washington, DC, USA
| | - April D Armstrong
- Department of Orthopeadics, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
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Desai SJ, Lalone E, Athwal GS, Ferreira LM, Johnson JA, King GJW. Hemiarthroplasty of the elbow: the effect of implant size on joint congruency. J Shoulder Elbow Surg 2016; 25:297-303. [PMID: 26700555 DOI: 10.1016/j.jse.2015.09.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 09/22/2015] [Accepted: 09/29/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Distal humeral hemiarthroplasty is a treatment option for elbow joint disease that predominantly affects the distal humerus, including distal humerus fractures, nonunions, and avascular necrosis. The effect of hemiarthroplasty implants on joint contact has not been reported. The purpose of this in vitro study was to quantify the effects of hemiarthroplasty and implant size on ulnohumeral joint congruency. METHODS Five fresh frozen cadaveric upper extremities were mounted to a custom elbow testing system. Active and passive motion were performed in dependent, horizontal, varus, and valgus positions. A registration and interbone distance algorithm was used to quantify ulnohumeral joint congruency throughout elbow flexion. RESULTS The optimally sized hemiarthroplasty implant demonstrated the greatest joint congruency with the ulna, followed by the oversized implant, then the undersized implant. Joint congruency was greater during active vs. passive flexion, indicating that the elbow joint is more reduced in active flexion than in passive flexion. CONCLUSION This study demonstrates that undersized distal humeral hemiarthroplasty implants have the lowest joint congruency compared with an optimally sized or oversized implant.
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Affiliation(s)
- Sagar J Desai
- Bioengineering Laboratory, Roth
- McFarlane Hand and Upper Limb Centre, Department of Surgery, Lawson Research Institute, St. Joseph's Health Care, Western University, London, ON, Canada
| | - Emily Lalone
- Bioengineering Laboratory, Roth
- McFarlane Hand and Upper Limb Centre, Department of Surgery, Lawson Research Institute, St. Joseph's Health Care, Western University, London, ON, Canada
| | - George S Athwal
- Bioengineering Laboratory, Roth
- McFarlane Hand and Upper Limb Centre, Department of Surgery, Lawson Research Institute, St. Joseph's Health Care, Western University, London, ON, Canada
| | - Louis M Ferreira
- Bioengineering Laboratory, Roth
- McFarlane Hand and Upper Limb Centre, Department of Surgery and Mechanical and Materials Engineering, Lawson Research Institute, St. Joseph's Health Care, Western University, London, ON, Canada
| | - James A Johnson
- Bioengineering Laboratory, Roth
- McFarlane Hand and Upper Limb Centre, Department of Surgery and Mechanical and Materials Engineering, Lawson Research Institute, St. Joseph's Health Care, Western University, London, ON, Canada
| | - Graham J W King
- Bioengineering Laboratory, Roth
- McFarlane Hand and Upper Limb Centre, Department of Surgery, Lawson Research Institute, St. Joseph's Health Care, Western University, London, ON, Canada.
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Willing R, King GJ, Johnson JA. Contact mechanics of reverse engineered distal humeral hemiarthroplasty implants. J Biomech 2015; 48:4037-4042. [DOI: 10.1016/j.jbiomech.2015.09.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 08/27/2015] [Accepted: 09/27/2015] [Indexed: 11/29/2022]
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Abstract
Total elbow arthroplasty is a good treatment alternative for selected patients with distal humerus fractures. Its attractiveness is related to several factors, including the possibility of performing the procedure; leaving the extensor mechanism intact; faster, easier rehabilitation compared with internal fixation; and overall good outcomes reported in terms of both pain relief and function. Implant failure leading to revision surgery does happen, and patients must comply with certain limitations to extend the longevity of their implant. Development of high-performance implants may allow expanding the indications of elbow arthroplasty for fractures.
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Affiliation(s)
- Luke S Harmer
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Joaquin Sanchez-Sotelo
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Pooley J, Salvador Carreno J. Total elbow joint replacement for fractures in the elderly--Functional and radiological outcomes. Injury 2015; 46 Suppl 5:S37-42. [PMID: 26362422 DOI: 10.1016/j.injury.2015.08.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIM The purpose of this paper was to review the literature on the treatment of intra-articular fractures of the distal humerus in the elderly in order to evaluate the place for total elbow replacement (TER) in the light of our experience over the past 15 years. METHODS A review of the records of 11 consecutive patients over the age of 60 years who underwent primary TER for comminuted fractures of the distal humerus between 1997 and 2011 were reviewed and the surviving patients were interviewed. The Scopus database was used to perform a pragmatic review of the literature published between the mid-1990s and the present-day. RESULTS At the time of the most recent follow-up 3.5 years following surgery (range: 2-6 years) 7 patients assessed with the Mayo elbow performance index were classified as excellent, 4 were classified as good. There were no complications requiring further procedures encountered. Five surviving patients remain satisfied with the function of their TER. The number of papers recommending TER for treatment of these fractures continues to increase with time. CONCLUSIONS TER is now the treatment of choice for unreconstructable fractures of the distal humerus in the elderly. This option should therefore be available at the time of surgery for all distal humeral fractures in this patient population. A surgical approach other than olecranon osteotomy, which would preclude TER is therefore required.
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Nestorson J, Ekholm C, Etzner M, Adolfsson L. Hemiarthroplasty for irreparable distal humeral fractures. Bone Joint J 2015; 97-B:1377-84. [DOI: 10.1302/0301-620x.97b10.35421] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report our experience of performing an elbow hemiarthroplasty in the treatment of comminuted distal humeral fractures in the elderly patients. A cohort of 42 patients (three men and 39 women, mean age 72; 56 to 84) were reviewed at a mean of 34.3 months (24 to 61) after surgery. Functional outcome was measured with the Mayo Elbow Performance Score (MEPS) and range of movement. The disabilities of the arm, shoulder and hand questionnaire (DASH) was used as a patient rated evaluation. Complications and ulnar nerve function were recorded. Plain radiographs were obtained to assess prosthetic loosening, olecranon wear and heterotopic bone formation. The mean extension deficit was 23.5° (0° to 60°) and mean flexion was 126.8° (90° to 145°) giving a mean arc of 105.5° (60° to 145°). The mean MEPS was 90 (50 to 100) and a mean DASH score of 20 (0 to 63). Four patients had additional surgery for limited range of movement and one for partial instability. One elbow was revised due to loosening, two patients had sensory ulnar nerve symptoms, and radiographic signs of mild olecranon wear was noted in five patients. Elbow hemiarthroplasty for comminuted intra-articular distal humeral fractures produces reliable medium-term results with functional outcome and complication rates, comparable with open reduction and internal fixation and total elbow arthroplasty. Cite this article: Bone Joint J 2015;97-B:1377–84.
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Affiliation(s)
| | - C. Ekholm
- Gothenburg University Institute of Clinical
Sciences at Sahlgrenska Academy, Gothenburg, Sweden
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Heijink A, Wagener ML, de Vos MJ, Eygendaal D. Distal humerus prosthetic hemiarthroplasty: midterm results. Strategies Trauma Limb Reconstr 2015; 10:101-8. [PMID: 26311568 PMCID: PMC4570889 DOI: 10.1007/s11751-015-0229-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 08/19/2015] [Indexed: 11/23/2022] Open
Abstract
Treatment of comminuted distal humeral fractures remains challenging. Open reduction–internal fixation remains the preferred treatment, but is not always feasible. In selected cases with non-reconstructable or highly comminuted fractures, total elbow arthroplasty has been used, however, also with relatively high complication and failure rates. Distal humerus prosthetic hemiarthroplasty (DHA) may be an alternative in these cases. The purpose of this study was to report the midterm results of six patients that were treated by DHA for acute and salvage treatment of non-reconstructable fractures of the distal humerus. All six patients were treated by DHA for acute and salvage treatment of non-reconstructable fractures of the distal humerus. Medical records were reviewed, and each patient was seen in the office. Mean follow-up was 54 months (range 21–76 months). Implant survival was 100 %. Three were pain free and three had mild or moderate residual pain. Average flexion–extension arc was 95.8° (range 70°–115°) and average pronation–supination arc was 165° (range 150°–180°). In three, there was some degree of instability, which was symptomatic in one. One had motoric and sensory sequelae of a partially recovered traumatic ulnar nerve lesion. According to the Mayo Elbow Performance Score, there were three excellent, one good and two poor results. Four were satisfied with the final result, and two were not. In this case series of six patients with DHA for non-reconstructable distal humerus fractures, favorable midterm follow-up results were seen; however, complications were also observed.
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Affiliation(s)
- Andras Heijink
- Department of Orthopaedic Surgery, Academic Medical Center (AMC), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. .,Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands.
| | - Marc L Wagener
- Department of Orthopaedic Surgery, St. Radboud University Hospital, Nijmegen, The Netherlands
| | - Maarten J de Vos
- Department of Orthopaedic Surgery, Tergooi Hospitals, Hilversum, The Netherlands
| | - Denise Eygendaal
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, The Netherlands
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Phadnis J, Banerjee S, Watts AC, Little N, Hearnden A, Patel VR. Elbow hemiarthroplasty using a "triceps-on" approach for the management of acute distal humeral fractures. J Shoulder Elbow Surg 2015; 24:1178-86. [PMID: 26117619 DOI: 10.1016/j.jse.2015.04.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 04/08/2015] [Accepted: 04/11/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total elbow arthroplasty is an established option for the primary treatment of acute distal humeral fractures, but there are sparse data regarding elbow hemiarthroplasty (EHA) as an alternative. We present the outcome of EHA performed with a modular anatomic prosthesis and a "triceps-on" surgical technique. METHODS Eighteen consecutive patients underwent EHA for an acute fracture. Two patients died, leaving a study group of 16 patients with minimum 2-year follow-up. Clinical evaluation included range of motion; Mayo Elbow Performance Score; Quick Disabilities of the Arm, Shoulder, and Hand score; and Oxford Elbow Score. Radiographic assessment looked at alignment, evidence of loosening, ulnar and radial head wear, heterotopic ossification, and whether healing of the condyles had occurred. RESULTS Mean follow-up was 35 months (24-79 months). The mean scores were as follows: Mayo Elbow Performance Score, 89.6; shortened Disabilities of the Arm, Shoulder, and Hand score, 11.2; and Oxford Elbow Score, 43.7. The mean flexion and pronation-supination arcs were 116° and 172° respectively. Radial head wear was absent in 13 patients and mild in 3. Ulnar wear was absent in 6 patients, mild in 8, and moderate in 2. Wear was not associated with greater pain or inferior functional scores. There was no sign of aseptic loosening, and complete condylar bone union occurred in 15 elbows. There was 1 complication, a transient ulnar nerve neurapraxia that resolved without intervention. CONCLUSION EHA with a modular anatomic implant using a triceps-on approach is a reliable technique for the management of acute unreconstructible distal humeral fractures in older patients.
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Affiliation(s)
| | | | | | - Nicholas Little
- Department of Orthopaedic, Epsom and St Helier University Hospitals NHS Trust, Epsom, Surrey, UK
| | | | - Vipul R Patel
- Department of Orthopaedic, Epsom and St Helier University Hospitals NHS Trust, Epsom, Surrey, UK
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Lechasseur B, Laflamme M, Leclerc A, Bédard AM. Incipient malunion of an isolated humeral trochlea fracture treated with an elbow hemiarthroplasty: case report. J Hand Surg Am 2015; 40:271-5. [PMID: 25542436 DOI: 10.1016/j.jhsa.2014.10.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 10/29/2014] [Accepted: 10/29/2014] [Indexed: 02/02/2023]
Abstract
We report the case of a 49-year-old woman with severe elbow ankylosis 10 weeks after a trochlea fracture treated with open reduction and internal fixation. Imaging confirmed failure of open reduction and internal fixation with a displaced and severely damaged trochlea. We treated the nascent malunited trochlea and associated elbow ankylosis with a distal humeral hemiarthroplasty and circumferential elbow arthrolysis. The patient regained functional range of motion of the elbow and had minimal pain. Distal humeral hemiarthroplasty, which has been indicated for acute fractures involving the capitellum or the entire distal humerus, may also be indicated for certain isolated complex fractures of the trochlea.
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Affiliation(s)
- Benoit Lechasseur
- Department of Orthopaedic Surgery, CHU de Québec, Hôpital Enfant-Jésus, Quebec, Canada; Department of Orthopaedic Surgery, CHU de Québec, Centre Hospitalier de l'Université Laval, Quebec, Canada
| | - Mélissa Laflamme
- Department of Orthopaedic Surgery, CHU de Québec, Hôpital Enfant-Jésus, Quebec, Canada; Department of Orthopaedic Surgery, CHU de Québec, Centre Hospitalier de l'Université Laval, Quebec, Canada.
| | - Alexandre Leclerc
- Department of Orthopaedic Surgery, CHU de Québec, Hôpital Enfant-Jésus, Quebec, Canada; Department of Orthopaedic Surgery, CHU de Québec, Centre Hospitalier de l'Université Laval, Quebec, Canada
| | - Anne-Marie Bédard
- Department of Orthopaedic Surgery, CHU de Québec, Hôpital Enfant-Jésus, Quebec, Canada; Department of Orthopaedic Surgery, CHU de Québec, Centre Hospitalier de l'Université Laval, Quebec, Canada
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40
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Dunn J, Kusnezov N, Pirela-Cruz M. Distal humeral hemiarthroplasty: indications, results, and complications. A systematic review. Hand (N Y) 2014; 9:406-12. [PMID: 25414601 PMCID: PMC4235903 DOI: 10.1007/s11552-014-9681-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Distal humeral hemiarthroplasty (DHH) is a treatment option for unreconstructable intra-articular distal humerus fractures. DHH may also be used in the setting of rheumatoid arthritis, orthopaedic tumor with significant bone loss, malunion, or osteomyelitis. DHH has specific advantages over other, more common, treatment modalities: total elbow arthroplasty (TEA) and open reduction internal fixation (ORIF). DHH is especially a reasonable option in younger patients to preserve bone stock, avoid significant weight restrictions, and limit loosening. METHODS The literature was reviewed for all cases of DHH for fracture and non-fracture indications between 1947 and 2014. Two hundred thirty-six papers were identified; 4 studies including 17 patients met criteria for non-fracture indications and 13 studies including 116 patients were identified for fracture indications. A systematic review was generated; patient indications, outcomes, and complications were recorded. RESULTS For non-fracture indications, good to excellent results were achieved in 76.5 % of patients with a mean arc of motion of 62° at mean follow up of 46.3 months. Half of the patients experienced a complication, most commonly stiffness. Loosening of the prosthesis was not noted in any patient. For fractures, good to excellent results were achieved in 67.4 % of patients with a mean arc of motion of 98.3° at a mean follow up of 42.2 months. One third of the patients experienced a complication but only 1.7 % experienced loosening of the prosthesis. CONCLUSION Here, we present the first review of the indications for DHH. DHH is a reasonable treatment option for older patients with unreconstructable intra-articular fractures of the distal humerus as well as younger patients with rheumatoid arthritis, orthopaedic tumor with significant bone loss, malunion, or osteomyelitis.
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Affiliation(s)
- John Dunn
- William Beaumont Army Medical Center, Department of Orthopaedic Surgery, 5005 N Piedras, Fort Bliss, TX 79920 USA
| | - Nicholas Kusnezov
- William Beaumont Army Medical Center, Department of Orthopaedic Surgery, 5005 N Piedras, Fort Bliss, TX 79920 USA
| | - Miguel Pirela-Cruz
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, 4800 Alberta Avenue, El Paso, TX 79920 USA
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Willing R, Lapner M, King GJW, Johnson JA. In vitro assessment of the contact mechanics of reverse-engineered distal humeral hemiarthroplasty prostheses. Clin Biomech (Bristol, Avon) 2014; 29:990-6. [PMID: 25238687 DOI: 10.1016/j.clinbiomech.2014.08.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/27/2014] [Accepted: 08/13/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Distal humeral hemiarthroplasty alters cartilage contact mechanics, which may predispose to osteoarthritis. Current prostheses do not replicate the native anatomy, and therefore contribute to these changes. We hypothesized that prostheses reverse-engineered from the native bone shape would provide similar contact patterns as the native articulation. METHODS Reverse-engineered hemiarthroplasty prostheses were manufactured for five cadaveric elbows based on CT images of the distal humerus. Passive flexion trials with constant muscle forces were performed with the native articulation intact while bone motions were recorded using a motion tracking system. Motion trials were then repeated after the distal humerus was replaced with a corresponding reverse-engineered prosthesis. Contact areas and patterns were reconstructed using computer models created from CT scan images combined with the motion tracker data. The total contact areas, as well as the contact area within smaller sub-regions of the ulna and radius, were analyzed for changes resulting from hemiarthroplasty using repeated-measures ANOVAs. FINDINGS Contact area at the ulna and radius decreased on average 42% (SD 19%, P=.008) and 41% (SD 42%, P=.096), respectively. Contact area decreases were not uniform throughout the different sub-regions, suggesting that contact patterns were also altered. INTERPRETATION Reverse-engineered prostheses did not reproduce the same contact pattern as the native joints, possibly because the thickness of the distal humerus cartilage layer was neglected when generating the prosthesis shapes or as a consequence of the increased stiffness of the metallic implants. Alternative design strategies and materials for hemiarthroplasty should be considered in future work.
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Affiliation(s)
- Ryan Willing
- Bioengineering Research Laboratory, Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, The University of Western Ontario, London, ON, Canada; Department of Mechanical Engineering, Binghamton University, Binghamton, NY, USA.
| | - Michael Lapner
- Bioengineering Research Laboratory, Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, The University of Western Ontario, London, ON, Canada
| | - Graham J W King
- Bioengineering Research Laboratory, Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, The University of Western Ontario, London, ON, Canada
| | - James A Johnson
- Bioengineering Research Laboratory, Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, The University of Western Ontario, London, ON, Canada
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