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Weber MM, Rausch V, Leschinger T, Müller LP, Hackl M. [Elbow hemiarthroplasty for coronal shear fractures of the distal humerus]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2024; 36:159-166. [PMID: 39037599 DOI: 10.1007/s00064-024-00852-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/10/2023] [Accepted: 11/09/2023] [Indexed: 07/23/2024]
Abstract
OBJECTIVE The aim of the operation is to replace the articular surface of the distal humerus in cases of nonreconstructible fractures of the distal humerus. INDICATIONS Active patients with high functional requirements, in whom weight limitation of total elbow arthroplasty should be avoided. CONTRAINDICATIONS Contraindications include fractures with irreconstructible epicondyles and/or irreconstructible collateral ligaments, as well as ulnohumeral, or radiohumeral osteoarthritis. SURGICAL TECHNIQUE Following subcutaneous anterior transposition of the ulnar nerve, surgical dislocation of the elbow joint is achieved through a paratricipital approach with release of the soft tissue structures from the humerus. After resection of the trochlea, the intramedullary canal of the humerus is prepared using rasps in order to implant the hemiprosthesis with retrograde cementing. Finally, the medial and lateral collateral ligaments as well as the flexors and extensors are repaired. POSTOPERATIVE MANAGEMENT Early functional rehabilitation in a hinged elbow orthosis while avoiding varus/valgus stress after wound healing is completed. RESULTS Between 2018 and 2022, 18 patients with coronal shear fractures were treated with elbow hemiarthroplasty. The mean Mayo Elbow Performance Score (MEPS) was 79 (70-95) after a mean follow-up of 12 months. The mean range of motion was 99° (70-130°) in extension-flexion and 162° (90-180°) in pronation-supination.
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Affiliation(s)
- Marc Maximilian Weber
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastisch-Ästhetische Chirurgie, Universitätsklinikum Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland.
| | - Valentin Rausch
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastisch-Ästhetische Chirurgie, Universitätsklinikum Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Tim Leschinger
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastisch-Ästhetische Chirurgie, Universitätsklinikum Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Lars Peter Müller
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastisch-Ästhetische Chirurgie, Universitätsklinikum Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland
| | - Michael Hackl
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastisch-Ästhetische Chirurgie, Universitätsklinikum Köln (AöR), Kerpener Str. 62, 50937, Köln, Deutschland
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Stoddart MT, Panagopoulos GN, Craig RS, Falworth M, Butt D, Rudge W, Higgs D, Majed A. A systematic review of the treatment of distal humerus fractures in older adults: A comparison of surgical and non-surgical options. Shoulder Elbow 2024; 16:175-185. [PMID: 38655404 PMCID: PMC11034469 DOI: 10.1177/17585732221099845] [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: 02/04/2022] [Revised: 04/24/2022] [Accepted: 04/24/2022] [Indexed: 04/26/2024]
Abstract
Background Fractures of the distal humerus are a common fragility fracture in older adults. The purpose of this study was to systematically review the literature to produce pooled estimates of the outcomes of treatment using total elbow arthroplasty (TEA), open reduction and locking plate fixation (ORIF), hemiarthroplasty or with conservative management. Methods A systematic review of PUBMED and EMBASE databases was conducted for studies reporting outcomes of intra-articular fractures in older adults. Data extracted included patient-reported outcome measures as well as clinical outcomes including ROM, adverse events and all-cause reoperation rates. Results Forty-eight studies met the inclusion criteria and included 1838 acute, intra-articular distal humeral fractures. There was no clinically important difference in patient-reported pain and function measured on the Mayo Elbow Performance Score (TEA = 89.3 (SD 20.0), Hemi = 88.4 (SD 10.6), internal fixation = 85.0 (SD 14.7), non-operative = 85.1 (SD 11.0)). Discussion Each of the treatment modalities studies resulted in a reasonable level of elbow function. The included studies were largely non-comparative and at considerable risk of bias. As elbow replacement surgery becomes centralised in the UK, there is a real need for high-quality comparative research studies to inform practice.
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Affiliation(s)
| | | | - Richard S. Craig
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, Oxford, UK
| | - Mark Falworth
- Shoulder & Elbow Service, Royal National Orthopaedic Hospital, Stanmore, UK
| | - David Butt
- Shoulder & Elbow Service, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Will Rudge
- Shoulder & Elbow Service, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Deborah Higgs
- Shoulder & Elbow Service, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Addie Majed
- Shoulder & Elbow Service, Royal National Orthopaedic Hospital, Stanmore, UK
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Taylor F, Page R, Wheeler J, Lorimer M, Corfield S, Peng Y, Burnton J. Distal humeral hemiarthroplasty compared to total elbow replacement for distal humeral fractures: a registry analysis of 906 procedures. J Shoulder Elbow Surg 2024; 33:356-365. [PMID: 37689104 DOI: 10.1016/j.jse.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/01/2023] [Accepted: 08/06/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Total elbow replacement (TER) is an accepted treatment for complex intra-articular distal humerus fractures in elderly patients. Distal humeral hemiarthroplasty (HA) is also a potential surgical option for unreconstructable fractures and avoids the concerns regarding mechanical wear and functional restrictions associated with TER. In the current literature, there are limited data available to compare the revision rates of HA and TER for the treatment of fracture. We used data from a large national arthroplasty registry to compare the outcome of HA and TER undertaken for fracture/dislocation and to assess the impact of demographics and implant choice on revision rates. METHODS Data obtained from the Australian Orthopaedic Association National Joint Replacement Registry from May 2, 2005, to December 31, 2021, included all procedures for primary elbow replacement with primary diagnosis of fracture or dislocation. The analyses were performed using Kaplan-Meier estimates of survivorship and hazard ratios (HRs) from Cox proportional hazards models. RESULTS There were 293 primary HA and 631 primary TER procedures included. The cumulative percentage revision (CPR) rate at 9 years was 9.7% for HA (95% confidence interval [CI] 6.0, 15.7), and 11.9% (95% CI 8.5, 16.6) for TER. When adjusted for age and gender, there was a significantly higher risk of revision after 3 months for TER compared to HA (HR 2.47, 95% CI 1.22, 5.03, P = .012). There was no difference in the rate of revision for patients aged <55 years or ≥75 years when HA and TER procedures were compared. In primary TER procedures, loosening was the most common cause of revision (3.6% of primary TER procedures), and the most common type of revision in primary TER involved revision of the humeral component only (2.6% of TER procedures). TER has a higher rate of first revision for loosening compared to HA (HR 4.21, 95% CI 1.29, 13.73; P = .017). In HA procedures, instability (1.7%) was the most common cause for revision. The addition of an ulna component was the most common type of revision (2.4% of all HA procedures). CONCLUSION For the treatment of distal humerus fractures, HA had a lower revision rate than TER after 3 months when adjusted for age and gender. Age <55 or ≥75 years was not a risk factor for revision when HA was compared to TER. Loosening leading to revision is more prevalent in TER and increases with time. In HA, the most common type of revision involved addition of an ulna component with preservation of the humeral component.
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Affiliation(s)
- Fraser Taylor
- Gold Coast University Hospital, Southport, QLD, Australia.
| | - Richard Page
- Barwon Centre of Orthopaedic Research and Education, Deakin University, Geelong, VIC, Australia; Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, SA, Australia
| | - James Wheeler
- Gold Coast University Hospital, Southport, QLD, Australia
| | - Michelle Lorimer
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, SA, Australia
| | - Sophie Corfield
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, SA, Australia
| | - Yi Peng
- Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, SA, Australia
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Jonsson EÖ, Ekholm C, Hallgren HB, Nestorson J, Etzner M, Adolfsson L. Elbow hemiarthroplasty and total elbow arthroplasty provided a similar functional outcome for unreconstructable distal humeral fractures in patients aged 60 years or older: a multicenter randomized controlled trial. J Shoulder Elbow Surg 2024; 33:343-355. [PMID: 37778655 DOI: 10.1016/j.jse.2023.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 08/11/2023] [Accepted: 08/27/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Semiconstrained total elbow arthroplasty (TEA) is an established treatment for elderly patients with distal humeral fractures not amenable to stable internal fixation (unreconstructable). In recent years, there has been increasing interest in elbow hemiarthroplasty (EHA), a treatment option which does not entail restrictions on weight-bearing as opposed to TEA. These 2 treatments have not been compared in a randomized controlled trial (RCT). The aim of this study was to compare the functional outcome of EHA and TEA for the treatment of unreconstructable distal humeral fractures in elderly patients. MATERIAL AND METHODS This was a multicenter randomized controlled trial (RCT). Patients were included between January 2011 and November 2019 at one of 3 participating hospitals. The inclusion criteria were an unreconstructable distal humeral fracture, age ≥60 years and independent living. The final follow-up took place after ≥2 years. The primary outcome measure was the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Secondary outcome measures were the Mayo Elbow Performance Score (MEPS), the EQ-5D index, range of motion (flexion, extension, pronation, and supination) and grip strength. RESULTS Forty patients were randomized to TEA (n = 20) and EHA (n = 20). Five patients died before completing the final follow-up, leaving 18 EHA and 17 TEA patients for analysis. There were 31 women. The mean age was 74.0 (SD, 8.5) years in the EHA group and 76.9 (SD, 7.6) in the TEA group (P = .30). The mean DASH score was 21.6 points in the EHA group and 27.2 in the TEA group (P = .39), a difference of -5.6 points (95% CI: -18.6 to 7.5). There were no differences between treatment with EHA and TEA for the mean values of the MEPS (85.0 vs. 88.2, P = .59), EQ-5D index (0.92 vs. 0.86, P = .13), extension (29° vs. 29°, P = .98), flexion (126° vs. 136°, P = .05), arc of flexion-extension (97° vs. 107°, P = .25), supination (81° vs. 75°, P = .13), pronation (78° vs. 74°, P = .16) or grip strength (17.5 kg vs. 17.2 kg, P = .89). There were 6 adverse events in each treatment group. CONCLUSION In this RCT, both elbow hemiarthroplasty (EHA) and total elbow arthroplasty (TEA) resulted in a good and similar functional outcome for unreconstructable distal humeral fractures in elderly patients at a minimum of 2 years of follow-up.
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Affiliation(s)
- Eythor Ö Jonsson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden.
| | - Carl Ekholm
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Hanna Björnsson Hallgren
- Division of Orthopaedic Surgery, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Jens Nestorson
- Division of Orthopaedic Surgery, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | | | - Lars Adolfsson
- Division of Orthopaedic Surgery, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Orthopaedics, Örebro University, Örebro, Sweden
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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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Coronal Plane Articular Shear Fractures of the Distal Humerus. J Am Acad Orthop Surg 2023; 31:e235-e245. [PMID: 36727959 DOI: 10.5435/jaaos-d-21-00291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 12/13/2022] [Indexed: 02/03/2023] Open
Abstract
Coronal plane articular shear fractures of the distal humerus are a rare injury, comprising 6% of distal humerus fractures. The fracture can be easily missed on initial radiographs; therefore, a high index of suspicion is warranted. Radiographically obvious fractures are often more complex than initially appreciated, with plain radiographs often underestimating the extent of posterior comminution and trochlear involvement. Associated bony and ligamentous injuries are common. Anatomic reduction and internal fixation of displaced fractures is the standard of care because poor results have been described with nonsurgical treatment. However, the regional anatomy and the often-limited bone stock can make open reduction and internal fixation challenging. The lateral approach, with headless compression screws placed from anterior to posterior, is commonly used for simpler fracture patterns, but exposure and fixation of trochlea extension can be difficult. In the absence of posterior comminution, the anterolateral approach can enhance trochlea exposure and allow for a better trajectory for screw placement. Posterior comminution often requires locking plate fixation. Better results and lower complication rates have been reported for fractures with less fragmentation of the articular surface and those without posterior comminution. Contracture and symptomatic implants are the most common reasons for revision surgery.
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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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8
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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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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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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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11
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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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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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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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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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20
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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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21
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Nestorson J, Rahme H, Adolfsson L. Arthroplasty as primary treatment for distal humeral fractures produces reliable results with regards to revisions and adverse events: a registry-based study. J Shoulder Elbow Surg 2019; 28:e104-e110. [PMID: 30342824 DOI: 10.1016/j.jse.2018.07.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 07/22/2018] [Accepted: 07/25/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND Primary prosthetic replacement has become an accepted method for the treatment of complex distal humeral fractures. The present study investigated implant survival and adverse events related to this procedure based on available Swedish registries and examined the completeness of the Swedish Elbow Arthroplasty register. MATERIALS AND METHODS Patients treated in Sweden with a primary elbow replacement due to a distal humeral fracture between 1999 and 2014 were identified through 3 different registries: The Swedish Elbow Arthroplasty Register, National Board of Health and Welfare inpatient register, and local registries of all orthopedic departments. Prosthetic survival was examined using Cox regression analysis with Kaplan-Meier plots. Adverse events, defined as medical treatment of the affected elbow besides revision, were analyzed separately. The study included 406 elbows in 405 patients, and no register was complete. RESULTS Implant survival at 10 years was 90% (95% confidence interval, 85%-96%), but only 45 patients had an observation time of 10 years or more because 46% of the patients had died, resulting in a mean observation time of 67 (standard deviation, 47) months. An increase in the use of hemiarthroplasties and a proportional decrease of total elbow arthroplasties was detected. There were 18 revisions (4%), and 26 patients (6%) experienced an adverse event, of whom 16 (4%) required surgery. The completeness of the Swedish Elbow Arthroplasty Register regarding primary arthroplasty was 81%. CONCLUSION Primary arthroplasty as treatment of distal humeral fractures produces reliable results with regards to revisions and other adverse events.
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Affiliation(s)
- Jens Nestorson
- Department of Experimental and Clinical Medicine, Linköping University, Linköping, Sweden.
| | - Hans Rahme
- Department of Orthopedics, Elisabeth Hospital, Uppsala, Sweden
| | - Lars Adolfsson
- Department of Experimental and Clinical Medicine, Linköping University, Linköping, Sweden
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22
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Duparc F, Merlet MC. Prevention and management of early treatment failures in elbow injuries. Orthop Traumatol Surg Res 2019; 105:S75-S87. [PMID: 30591417 DOI: 10.1016/j.otsr.2018.05.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/24/2018] [Accepted: 05/05/2018] [Indexed: 02/02/2023]
Abstract
The appropriate management of early treatment failures in patients with elbow injuries requires the identification of the cause of failure. In this work, six types of elbow injury are considered: (i) identification of early failed reduction of a dislocation or fracture-dislocation of the elbow should lead to a repeat reduction procedure, testing for elbow instability, and ligament repair, followed by the use of a hinged external fixator to allow early mobilisation. Differentiating an isolated dislocation from a dislocation combined with a fracture of the coracoid process is crucial. Re-implantation of the coronoid process allows repair of the ligaments and restoration of stability in the sagittal plane; (ii) early secondary displacement of a distal humeral fracture after internal fixation is usually due to insufficient fixation confined to a single humeral pillar. If both humeral pillars are fractured, then both must be repaired; (iii) early treatment failure of an intra-articular distal humeral fracture in an elderly patient with bone loss warrants distal humeral hemiarthroplasty or total elbow arthroplasty; (iv) in fractures of the olecranon, treatment failures are due to insufficient fixation or to a mistaken diagnosis of trans-olecranon fracture-dislocation; (v) in fractures of the radial head, causes of early revision include excessive tilting of the head in radial neck fractures, with secondary displacement due to insufficient internal fixation, and adverse effects on the wrist of radial head resection performed without assessing the ulnar variance. In patients with radial head fractures, no treatment decisions can be made before performing an anteroposterior radiograph of the wrist; (vii) in fracture-dislocations of both the radius and ulna, accurate reduction of the ulnar fracture is a pre-requisite to proper reduction of the radio-humeral and proximal radio-ulnar joints. An early postoperative assessment, within 10 days after surgery, is of paramount importance to re-evaluate the initial treatment and, if needed, to introduce modifications. Early failure of the initial treatment of an elbow injury should lead to the prompt implementation of corrective measures: follow-up anteroposterior and lateral radiographs must be obtained on day 8 to ensure the diagnosis of initial treatment failure and to allow the institution of an appropriate management strategy; the dogma stating that the elbow should never be immobilised remains valid, and every effort should be made to ensure that mobilisation starts as early as possible.
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Affiliation(s)
- Fabrice Duparc
- Chirurgie orthopédique et traumatologique, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France.
| | - Marie-Caroline Merlet
- Chirurgie orthopédique et traumatologique, CHU Charles-Nicolle, 1, rue de Germont, 76031 Rouen, France
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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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25
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Intra-articular fractures of the distal humerus-a review of the current practice. INTERNATIONAL ORTHOPAEDICS 2018; 42:2653-2662. [PMID: 29404666 DOI: 10.1007/s00264-017-3719-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 12/10/2017] [Indexed: 10/18/2022]
Abstract
Intra-articular fractures of the distal humerus are complex injuries that can considerably limit elbow function if not treated appropriately. Surgical management is indicated for most intra-articular distal humerus fractures with the goal of restoring elbow range of motion and function. Open reduction and internal fixation (ORIF) with plates and screws has been the preferred surgical option. Double plating is recommended for bicolumnar fractures and plates can be applied either parallel or orthogonal to each other. Surgical approach for ORIF of the distal humerus can be performed through an olecranon osteotomy, but other approaches that preserve the olecranon are also in use, such as the triceps-reflecting, triceps-splitting, paratricipital, and triceps-reflecting anconeus pedicle approach. The ulnar nerve is identified during the approach, followed by either in situ decompression or anterior transposition. Elbow arthroplasty has also emerged as a viable alternative to ORIF for fixation of these fractures in elderly patients with poor bone quality.
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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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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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Claessen FMAP, Stoop N, Doornberg JN, Guitton TG, van den Bekerom MPJ, Ring D, Chauhan A, Wahegaonkar A, Shafritz A, Garcia G A, Miller A, Barquet A, Kristan A, Apard T, Armstrong A, Berner A, Jubel A, Kreis B, Babis C, Sutker B, Sears B, Nolan B, Crist B, Cross B, Wills B, Barreto C, Ekholm C, Swigart C, Oliveira Miranda C, Manke C, Zalavras C, Goldfarb C, Cassidy C, Walsh C, Jones C, Garnavos C, Young C, Moreno-Serrano C, Lomita C, Klostermann C, van Deurzen D, Rikli D, Polatsch D, Beingessner D, Drosdowech D, Eygendaal D, Patel M, Brilej D, Walbeehm E, Ballas E, Ibrahim E, Melamed E, Stojkovska Pemovska E, Hofmeister E, Hammerberg E, Kaplan F, Suarez F, Fernandes C, Lopez-Gonzalez F, Walter F, Frihagen F, Kraan G, Kontakis G, Dyer G, Kohut G, Panagopoulos G, Hernandez G, Porcellini G, Bayne G, Merrell G, DeSilva G, Della Rocca G, Bamberger H, Broekhuyse H, Durchholz H, Kodde I, McGraw I, Harris I, Pountos I, Wiater J, Choueka J, Kazanjian J, Gillespie J, Biert J, Fanuele J, Johnson J, Greenberg J, Abrams J, Hall J, Fischer J, Scheer J, Itamura J, Capo J, Braman J, Rubio J, Ortiz J, Filho J, Nolla J, Abboud J, Conflitti J, Abzug J, Patiño J, Rodríguez Roiz J, Adams J, Bishop J, Kabir K, Chivers K, Prommersberger K, Egol K, Rumball K, Dickson K, Jeray K, Poelhekke L, Campinhos L, Mica L, Borris L, Adolfsson L, Schulte L, Elmans L, Lane L, Paz L, Taitsman L, Guenter L, Austin L, Waseem M, Palmer M, Abdel-Ghany M, Richard M, Rizzo M, Pirpiris M, Di Micoli M, Bonczar M, Loebenberg M, Richardson M, Mormino M, Menon M, Soong M, Wood M, Meylaerts S, Darowish M, Nancollas M, Prayson M, Grafe M, Kessler M, Kaminaris M, Pirela-Cruz M, Mckee M, Merchant M, Tyllianakis M, Shafi M, Powell A, Shortt N, Felipe N, Parnes N, Bijlani N, Elias N, Akabudike N, Rossiter N, Lasanianos N, Kanakaris N, Brink O, van Eerten P, Paladini P, Martineau P, Appleton P, Levin P, Althausen P, Evans P, Jebson P, Krause P, Schandelmaier P, Peters A, Dantuluri P, Blazar P, Andreas P, Inna P, Quell M, Ramli R, de Bedout R, Ranade A, Ashish S, Smith R, Babst R, Omid R, Buckley R, Jenkinson R, Gilbert R, Page R, Papandrea R, Zura R, Gray R, Wagenmakers R, Pesantez R, van Riet R, Calfee R, van Helden S, Bouaicha S, Kakar S, Kaplan S, Scott F, Kaar S, Mitchell S, Rowinski S, Dodds S, Kennedy S, Beldner S, Schepers T, Guitton T, Gosens T, Baxamusa T, Taleb C, Tosounidis T, Wyrick T, Begue T, DeCoster T, Dienstknecht T, Varecka T, Mittlmeier T, Fischer T, Chesser T, Omara T, Bafus T, Siff T, Havlicek T, Sabesan V, Nikolaou V, Philippe V, Giordano V, Vochteloo A, Batson W, Hammert W, Satora W, Weil Y, Ruch D, Marsh L, Swiontkowski M, Hurwit S. Interpretation of Post-operative Distal Humerus Radiographs After Internal Fixation: Prediction of Later Loss of Fixation. J Hand Surg Am 2016; 41:e337-e341. [PMID: 27522299 DOI: 10.1016/j.jhsa.2016.07.094] [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: 11/30/2015] [Revised: 04/17/2016] [Accepted: 07/13/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE Stable fixation of distal humerus fracture fragments is necessary for adequate healing and maintenance of reduction. The purpose of this study was to measure the reliability and accuracy of interpretation of postoperative radiographs to predict which implants will loosen or break after operative treatment of bicolumnar distal humerus fractures. We also addressed agreement among surgeons regarding which fracture fixation will loosen or break and the influence of years in independent practice, location of practice, and so forth. METHODS A total of 232 orthopedic residents and surgeons from around the world evaluated 24 anteroposterior and lateral radiographs of distal humerus fractures on a Web-based platform to predict which implants would loosen or break. Agreement among observers was measured using the multi-rater kappa measure. RESULTS The sensitivity of prediction of failure of fixation of distal humerus fracture on radiographs was 63%, specificity was 53%, positive predictive value was 36%, the negative predictive value was 78%, and accuracy was 56%. There was fair interobserver agreement (κ = 0.27) regarding predictions of failure of fixation of distal humerus fracture on radiographs. Interobserver variability did not change when assessed for the various subgroups. CONCLUSIONS When experienced and skilled surgeons perform fixation of type C distal humerus fracture, the immediate postoperative radiograph is not predictive of fixation failure. Reoperation based on the probability of failure might not be advisable. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic III.
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Affiliation(s)
- Femke M A P Claessen
- Orthopaedic Hand and Upper Extremity Service, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Nicky Stoop
- Orthopaedic Hand and Upper Extremity Service, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Job N Doornberg
- Orthotrauma Research Center Amsterdam, University of Amsterdam Orthopaedic Residency Program, Amsterdam, The Netherlands
| | - Thierry G Guitton
- Orthotrauma Research Center Amsterdam, University of Amsterdam Orthopaedic Residency Program, Amsterdam, The Netherlands
| | | | - David Ring
- Orthopaedic Hand and Upper Extremity Service, Harvard Medical School, Massachusetts General Hospital, Boston, MA.
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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
Fractures of the distal humerus in the adult comprise approximately one third of all humeral fractures. Successful management of distal humerus fractures depends on correct reduction of the fracture, reconstruction of the articular surface if needed, stability and rigidity of the fixation, and appropriate rehabilitation. In this review, we evaluated the available literature and highlighted current therapy concepts. We assessed the evolution of internal fixation and elbow arthroplasty focusing on the established surgical approaches against the background of a growing incidence of distal humeral fractures in an aging patient population. Therefore evaluating the aspect and influence of age-dependent comorbidities like osteoporosis on successful treatment.
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Affiliation(s)
- Steinitz Amir
- Department of Traumatology and Orthopedic Surgery, University Hospital Basel, Spitalstr. 21, 4031 Basel, Switzerland
| | - Sailer Jannis
- Department of Traumatology and Orthopedic Surgery, University Hospital Basel, Spitalstr. 21, 4031 Basel, Switzerland
| | - Rikli Daniel
- Department of Traumatology and Orthopedic Surgery, University Hospital Basel, Spitalstr. 21, 4031 Basel, Switzerland
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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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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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Plate and Screw Fixation of Bicolumnar Distal Humerus Fractures: Factors Associated With Loosening or Breakage of Implants or Nonunion. J Hand Surg Am 2015; 40:2045-2051.e2. [PMID: 26319772 DOI: 10.1016/j.jhsa.2015.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 07/06/2015] [Accepted: 07/06/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify factors associated with reoperation for early loosening or breakage of implants or nonunion after operative treatment of AO type C distal humerus fractures. METHODS We retrospectively analyzed 129 adult patients who had operative treatment of an isolated AO type C distal humerus fracture at 1 of 5 hospitals to determine factors associated with reoperation for early loosening or breakage of implants or nonunion. RESULTS Within 6 months of original fixation, 16 of 129 fractures (12%) required reoperation for loosening or breakage of implants (n = 8) or nonunion (n = 8). In bivariate analyses, the Charlson comorbidity index, smoking, a coded diagnosis of obesity, diabetes mellitus, and radiographic osteoarthritis were significantly associated with reoperation for early loosening or breakage of implants or nonunion. CONCLUSIONS With the numbers available, patient factors rather than technical factors were associated with reoperation for loosening or breakage of implants and nonunion. Because of the relative infrequency of fixation problems and nonunion, a much larger study is needed to address technical deficiencies.
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40
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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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41
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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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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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Mansat P, Bonnevialle N, Rongières M, Bonnevialle P. The role of total elbow arthroplasty in traumatology. Orthop Traumatol Surg Res 2014; 100:S293-8. [PMID: 25164351 DOI: 10.1016/j.otsr.2014.06.008] [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: 05/16/2014] [Accepted: 06/26/2014] [Indexed: 02/02/2023]
Abstract
UNLABELLED Fractures of the distal humerus account for 5% of osteoporotic fractures in subjects older than 60 years. A history of osteoporosis, co-morbidities, and joint comminution make their management difficult. The therapeutic options are limited to functional treatments, osteosynthesis, or either partial or total arthroplasty. Functional treatment of distal humerus fractures in the elderly subject provide inconsistent results, often with persistence of pain with a stiff or unstable elbow. Osteosynthesis remains the reference treatment for these fractures, following the principle of stable and rigid osteosynthesis allowing early mobilization. However, joint comminution and a history of osteoporosis occasionally make it impossible to meet this objective, with a considerable rate of complications and surgical revisions. Total elbow arthroplasty remains an alternative to osteosynthesis with very satisfactory immediate results restoring a painless, stable, and functional elbow. These results seem reproducible and sustainable over time. The complication rate is not uncommon with an approximately 10% surgical revision rate. Elbow hemiarthroplasty remains to be validated in this indication. LEVEL OF EVIDENCE V.
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Affiliation(s)
- P Mansat
- Départementd'orthopédie-traumatologie, hôpital Riquet, centre hospitalier universitaire de Toulouse, place du Dr Baylac, 31059 Toulouse, France.
| | - N Bonnevialle
- Départementd'orthopédie-traumatologie, hôpital Riquet, centre hospitalier universitaire de Toulouse, place du Dr Baylac, 31059 Toulouse, France
| | - M Rongières
- Départementd'orthopédie-traumatologie, hôpital Riquet, centre hospitalier universitaire de Toulouse, place du Dr Baylac, 31059 Toulouse, France
| | - P Bonnevialle
- Départementd'orthopédie-traumatologie, hôpital Riquet, centre hospitalier universitaire de Toulouse, place du Dr Baylac, 31059 Toulouse, France
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Lapner M, Willing R, Johnson JA, King GJW. The effect of distal humeral hemiarthroplasty on articular contact of the elbow. Clin Biomech (Bristol, Avon) 2014; 29:537-44. [PMID: 24780463 DOI: 10.1016/j.clinbiomech.2014.03.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 03/25/2014] [Accepted: 03/25/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hemiarthroplasty is a treatment option for selected distal humerus fractures. The purpose of this study was to determine the effect of distal humeral hemiarthroplasty and implant size on elbow articular contact. We hypothesized that implants of varying sizes produce different contact patterns compared with the native elbow. METHODS Eight cadaveric arms were tested in an elbow simulator and the kinematics recorded. Three-dimensional reconstructions of bones and cartilage were generated from computed-tomography images to determine contact patterns. The native articulation was compared to optimal, oversized, and undersized implants (Latitude Anatomic Hemiarthroplasty). Changes in contact patterns relative to the native articulation were measured using total contact area and contact patch agreement scores, defined as the sum of distance between contact patches×area, indicating how well contact patches agree with the native contact pattern. FINDINGS The native articulation had significantly lower ulnohumeral contact patch agreement scores compared to all tested implants (P<0.05). Mean ulnohumeral and radiocapitellar contact area decreased an average 44% (P=0.03) and 4% (P=0.07) following placement of an optimally sized implant. There was no effect of implant size on contact area or contact patch agreement score (P>0.05). INTERPRETATION Shape differences of elbow implants relative to the native joint may be responsible for altered contact patterns and could be improved with design modifications. These changes may predispose the elbow to arthritis. The lack of influence of implant size suggests that implant shape and materials may be more important than implant sizing during surgery.
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Affiliation(s)
- Michael Lapner
- Division of Orthopedic Surgery, Sturgeon Hospital, University of Alberta, 201 Boudreau Rd, St. Albert, Alberta T8N 6C4, Canada
| | - Ryan Willing
- Mechanical Engineering Department, Thomas J. Watson School of Engineering & Applied Science, Binghamton University - SUNY, P.O. Box 6000, Binghamton, NY 13902-6000, USA
| | - James A Johnson
- Biomedical Engineering, Department of Surgery, Roth
- McFarlane Hand and Upper Limb Centre Bioengineering Laboratory, St. Joseph's Health Centre, 268 Grosvenor St., London, Ontario N6A 4L6, Canada; Department of Mechanical and Materials Engineering, Western University, Roth
- McFarlane Hand and Upper Limb Centre Bioengineering Laboratory, St. Joseph's Health Centre, 268 Grosvenor St., London, Ontario N6A 4L6, Canada
| | - Graham J W King
- Western University, Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, 268 Grosvenor St., Room D0-202, London, Ontario N6A 4L6, Canada.
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