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Celli A, Prandini M, Cheli A, Pederzini LA. Elbow stiffness: Arthritis and heterotopic ossification. J ISAKOS 2024; 9:103-114. [PMID: 37879605 DOI: 10.1016/j.jisako.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/11/2023] [Accepted: 10/17/2023] [Indexed: 10/27/2023]
Abstract
In elbow stiffness, pre-operative assessments should identify the articular and peri-articular tissues involved and, more specifically, they should determine how preserved the articular surfaces and osteo-articular congruity are. We will focus on the most important conditions and tissue reactions after trauma in order to understand the causes of joint stiffness. A logical surgical planning is based upon a deep knowledge of the anatomical obstacles and of the associated lesions that the trauma provoked with. The peri-articular soft tissue contractures. The osteo-articular incongruity.
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Affiliation(s)
- Andrea Celli
- Department of Orthopaedic and Traumatology Surgery, Shoulder and Elbow Unit, Hesperia Hospital, Modena 41124, Italy.
| | - Mauro Prandini
- Department of Orthopaedic, Traumatology and Arthroscopic Surgeries, Nuovo Ospedale di Sassuolo, Modena 41124, Italy
| | - Andrea Cheli
- Department of Orthopaedic, Traumatology and Arthroscopic Surgeries, Nuovo Ospedale di Sassuolo, Modena 41124, Italy
| | - Luigi Adriano Pederzini
- Department of Orthopaedic, Traumatology and Arthroscopic Surgeries, Nuovo Ospedale di Sassuolo, Modena 41124, Italy
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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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3
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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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4
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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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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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Coronal Shear Fractures of the Distal Humerus. J Funct Morphol Kinesiol 2022; 7:jfmk7010007. [PMID: 35076551 PMCID: PMC8788494 DOI: 10.3390/jfmk7010007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/24/2021] [Accepted: 12/30/2021] [Indexed: 11/16/2022] Open
Abstract
Coronal shear fractures of the distal humerus are rare, frequently comminuted, and are without consensus for treatment. The aim of this paper is to review the current concepts on the diagnosis, classification, treatment options, surgical approaches, and complications of capitellar and trochlear fractures. Computed Tomography (CT) scans, along with the Dubberley classification, are extremely helpful in the decision-making process. Most of the fractures necessitate open reduction and internal fixation, although elbow arthroplasty is an option for comminuted fractures in the elderly low-demand patient. Stiffness is the most common complication after fixation, although reoperation is infrequent.
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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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9
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Watson JJ, Bellringer S, Phadnis J. Coronal shear fractures of the distal humerus: Current concepts and surgical techniques. Shoulder Elbow 2020; 12:124-135. [PMID: 32313562 PMCID: PMC7153208 DOI: 10.1177/1758573219826529] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/07/2018] [Accepted: 01/02/2019] [Indexed: 12/17/2022]
Abstract
Coronal shear fractures of the distal humerus are a unique subset of distal humeral fractures which entail partial or complete articular fractures of the distal humerus without involvement of the columns. The very distal nature of these fragments, their small size and propensity for comminution render them challenging to treat surgically. The purpose of this article is to describe the classification, outcomes and surgical techniques currently used for the treatment of these fractures using the available literature and authors' clinical experience.
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Affiliation(s)
| | | | - Joideep Phadnis
- J Phadnis, Montefiore hospital, Montefiore Road, Hove, BN3 1RD, UK.
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10
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Outcomes After Hemiarthroplasty of the Elbow for the Management of Posttraumatic Arthritis: Minimum 2-Year Follow-up. J Am Acad Orthop Surg 2019; 27:727-735. [PMID: 30789379 DOI: 10.5435/jaaos-d-18-00055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Hemiarthroplasty (HA) of the elbow represents an alternative to total elbow arthroplasty (TEA) without the associated activity restrictions. This study reviews our experience with distal humerus HA with minimum 2-year follow-up. METHODS Between 2002 and 2012, 16 elbows underwent HA for posttraumatic arthritis of the elbow. Patients were followed for a minimum of 2 years or until revision surgery. Outcome measures included pre- and postoperative Mayo Elbow Performance Scores (MEPSs), complications, and revisions. RESULTS Mean age at arthroplasty was 45 years, and follow-up averaged 51 months. All patients had previously undergone one or more surgical procedures at the elbow (average of 1.5 procedures). At follow-up, five had undergone additional surgery; two were revised to TEA. In surviving implants, the range of motion at follow-up was markedly improved from preoperative motion. The MEPS for the remaining HA included five excellent results, three good results, five fair results, and one poor result. DISCUSSION Elbow HA is an option for young or active patients with end-stage elbow posttraumatic arthritis who are unwilling to accept activity limitations. However, high rates of revision surgery and revision to TEA occur after HA for posttraumatic osteoarthritis of the elbow. Only 57% of patients with surviving implants had a good to excellent MEPS, although improvement in the range of motion was predictable.
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Goodman AD, Johnson JP, Kleiner JE, Gil JA, Daniels AH. The expanding use of total elbow arthroplasty for distal humerus fractures: a retrospective database analysis of 56,379 inpatients from 2002-2014. PHYSICIAN SPORTSMED 2018; 46:492-498. [PMID: 30073892 DOI: 10.1080/00913847.2018.1508315] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Distal humerus fractures are challenging to treat, with significant morbidity. Precontoured distal humerus locking plates and total elbow arthroplasty implants have become available in the past 15 years, potentially offering the promise of improved outcomes. However, national data regarding the usage of and in-hospital complications associated with these implants is scarce. Therefore, we aimed to determine if the incidence of inpatients with distal humerus fractures treated with arthroplasty or open reduction and internal fixation (ORIF) changed over time. Secondarily, we sought to determine what demographic factors were associated with arthroplasty versus fixation and compare inpatient outcomes. METHODS Inpatients over 50 years old with operatively treated closed distal humerus fractures were identified between 2002 and 2014 in the Nationwide Inpatient Sample, a nationally representative, all-payer database. Patient demographic factors were associated with treatment type. Outcomes examined included complications, mortality, length-of-stay, and charges; multivariable logistic regression compared associations with treatment. RESULTS Of 56,379 inpatients undergoing surgery, the proportion undergoing arthroplasty rose 2.3-fold from 4.8% to 10.9% from 2002 to 2014 (OR 1.039/year [95% CI [1.016-1.062]). Annual patient volume remained similar. Arthroplasty patients were older than those undergoing fixation (75.5 vs. 71.0 years, p < 0.001), more likely to be female (83.1% vs. 75.4%, p < 0.001), and less likely to be treated at a rural hospital (OR 0.601, 95% CI 0.445-0.812, p < 0.001). There was no significant difference in comorbidities. Arthroplasty patients had similar inpatient medical complication (7.1% vs. 7.8%, OR 0.998, p = 0.988) and mortality rates (0.38% vs. 0.94%, OR 0.426, p = 0.102), a decreased length of stay (by 0.3 days, p = 0.032), but increased hospital charges (by $12,033, p < 0.001). CONCLUSIONS For inpatients over 50 years old with operatively-treated distal humerus fractures, use of elbow arthroplasty has expanded, albeit with increased cost. Further studies may help to delineate the long-term costs and benefits, as well as which patients may benefit from each type of implant. LEVEL OF EVIDENCE Level III, Therapeutic Study.
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Affiliation(s)
- Avi D Goodman
- a Brown University/Rhode Island Hospital - Orthopaedics , Providence , RI , USA
| | - Joseph P Johnson
- a Brown University/Rhode Island Hospital - Orthopaedics , Providence , RI , USA
| | - Justin E Kleiner
- b Warren Alpert Medical School of Brown University , Providence , RI , USA
| | - Joseph A Gil
- a Brown University/Rhode Island Hospital - Orthopaedics , Providence , RI , USA
| | - Alan H Daniels
- a Brown University/Rhode Island Hospital - Orthopaedics , Providence , RI , USA
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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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Gallucci G, Larrondo Calderón W, Boretto J, Castellaro Lantermo J, Terán J, de Carli P. Total elbow arthroplasty for the treatment of distal humeral fractures. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016. [DOI: 10.1016/j.recote.2016.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Gallucci GL, Larrondo Calderón W, Boretto JG, Castellaro Lantermo JA, Terán J, de Carli P. Total elbow arthroplasty for the treatment of distal humeral fractures. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016; 60:167-74. [PMID: 26948532 DOI: 10.1016/j.recot.2015.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 10/29/2015] [Accepted: 12/30/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To report the clinical-functional outcomes of the treatment of humeral distal fractures with a total elbow prosthesis. MATERIAL AND METHODS This retrospective study was performed in two surgical centres. A total of 23patients were included, with a mean age of 79years, and of which 21 were women. The inclusion criteria were: patients with humeral distal fractures, operated on using a Coonrad-Morrey prosthesis, and with a follow-up of more than one year. According to AO classification, 15fractures were type C3, 7 C2 and 1 A2. All patients were operated on without de-insertion of the extensor mechanism. The mean follow-up was 40 months. RESULTS Flexor-extension was 123-17°, with a total mobility arc of 106° (80% of the contralateral side). Pain, according to a visual analogue scale was 1. The Mayo Elbow Performance Index (MEPI) was 83 points. Excellent results were obtained in 8 patients, good in 13, medium in 1, and poor in 1. The mean DASH (disability) score was 24 points. CONCLUSION Treatment of humeral distal fractures with total elbow arthroplasty could be a good treatment option, but indications must be limited to patients with complex fractures, poor bone quality, with osteoporosis and low functional demands. In younger patients, the use is limited to serious cases where there is no other treatment option. LEVEL OF EVIDENCE Level of Evidence IV.
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Affiliation(s)
- G L Gallucci
- Servicio de Ortopedia y Traumatología «Dr. Carlos E. Ottolenghi», Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | | | - J G Boretto
- Servicio de Ortopedia y Traumatología «Dr. Carlos E. Ottolenghi», Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - J Terán
- Servicio de Traumatología, Clínica Dávila, Santiago, Chile
| | - P de Carli
- Servicio de Ortopedia y Traumatología «Dr. Carlos E. Ottolenghi», Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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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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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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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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Hemiarthroplasty of the elbow: the effect of implant size on kinematics and stability. J Shoulder Elbow Surg 2014; 23:946-54. [PMID: 24766788 DOI: 10.1016/j.jse.2014.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 01/29/2014] [Accepted: 02/10/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Distal humeral hemiarthroplasty is a treatment option for distal humeral fractures, nonunions, and avascular necrosis. The biomechanical effects, however, have not been reported. The purpose of this in vitro study was to quantify the effects of hemiarthroplasty and implant size on elbow joint kinematics. METHODS Eight fresh-frozen cadaveric arms were mounted in an in vitro motion simulator. An electromagnetic tracking system quantified elbow kinematics. A custom distal humeral stem was implanted by use of navigation, and 3 humeral articular spools were evaluated: optimally sized, undersized, and oversized. Statistical analysis was performed with repeated-measures analysis of variance. RESULTS Distal humeral hemiarthroplasty altered elbow kinematics, regardless of implant size. In the valgus position, the optimally sized implant resulted in a mean increase in valgus angulation of 3° ± 1° (P = .003) as compared with the osteotomy control. In the varus position, the optimal and undersized implants both resulted in significant increases in varus angulation: 3° ± 1° (P = .01) and 3° ± 1° (P = .001), respectively. The undersized implant had the greatest alteration in kinematics, whereas the oversized implant best reproduced native elbow kinematics. CONCLUSION This study showed a small but significant alteration in elbow joint kinematics with placement of a distal humeral hemiarthroplasty implant, regardless of implant size. This could be due to errors in implant positioning and/or differences in the shape of the humeral implant relative to the native elbow. These changes in joint tracking may cause abnormal articular contact and loading, which may result in pain and cartilage degeneration over time.
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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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Hohman DW, Nodzo SR, Qvick LM, Duquin TR, Paterson PP. Hemiarthroplasty of the distal humerus for acute and chronic complex intra-articular injuries. J Shoulder Elbow Surg 2014; 23:265-72. [PMID: 23790327 DOI: 10.1016/j.jse.2013.05.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Revised: 04/21/2013] [Accepted: 05/02/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Comminuted intra-articular distal humeral fractures represent a challenging upper extremity injury. This study reviews clinical and radiographic results in patients with distal humeral hemiarthroplasty (DHH). METHODS DHH with the Latitude prosthesis (Tornier, Saint-Ismier, France) was performed in 8 patients (mean age, 64 years; age range, 33-75 years) for unreconstructible fractures of the distal humerus or salvage of failed internal fixation. Clinical outcomes were assessed with the American Shoulder and Elbow Surgeons elbow instrument; Mayo Elbow Performance Index; and Disabilities of the Arm, Shoulder and Hand questionnaire at a mean of 36 months. Radiologic assessment included radiographs and computed tomography to evaluate olecranon wear and densitometry (dual-energy x-ray absorptiometry). Range of motion, pain, and elbow satisfaction were recorded, and descriptive statistics were used for analysis. RESULTS Seven patients were available to participate in the follow-up examination. Acute cases (5 patients) scored better than salvage cases (2 patients) on the Mayo Elbow Performance Score (80 points [range, 67-95 points] and 65 points [range, 50-80 points], respectively) and Disabilities of the Arm, Shoulder and Hand score (31 points [range, 2.5-68 points] and 39 points [range, 17-62 points], respectively). The mean arc of elbow flexion and extension was 96° (range, 70°-130°), with mean flexion of 120° (range, 90°-135°) and a mean extension loss of 19° (range, 5°-30°). The mean arc of forearm rotation was 160° (range, 140°-180°). Reoperation was required in 4 patients because of painful retained hardware. Five patients reported pain with activities of daily living. CONCLUSION DHH should be used with caution until such time as longer-term outcome studies are able to show the efficacy of this procedure.
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Affiliation(s)
- Donald W Hohman
- Department of Orthopedics, University at Buffalo, The State University of New York, Buffalo, NY, USA.
| | - Scott R Nodzo
- Department of Orthopedics, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Lars M Qvick
- Department of Orthopedics, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Thomas R Duquin
- Department of Orthopedics, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Paul P Paterson
- Department of Orthopedics, University at Buffalo, The State University of New York, Buffalo, NY, USA
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Ditsios K, Boutsiadis A, Agathangelidis F, Tyllianakis M, Christodoulou A. Elbow Hemiarthroplasty for Late Reconstruction of a Traumatic Elbow Bone Defect in a Young Patient: A Case Report. JBJS Case Connect 2013; 3:e129. [PMID: 29252285 DOI: 10.2106/jbjs.cc.m.00137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Konstantinos Ditsios
- First Orthopaedic Department of Aristotelian University of Thessaloniki, "G. Papanikolaou" General Hospital, 57010, Exohi, Thessaloniki, Greece. . . .
| | - Achilleas Boutsiadis
- First Orthopaedic Department of Aristotelian University of Thessaloniki, "G. Papanikolaou" General Hospital, 57010, Exohi, Thessaloniki, Greece. . . .
| | - Filon Agathangelidis
- First Orthopaedic Department of Aristotelian University of Thessaloniki, "G. Papanikolaou" General Hospital, 57010, Exohi, Thessaloniki, Greece. . . .
| | - Minos Tyllianakis
- Department of Orthopaedic Surgery, Medical School, University of Patras, Rion 26504, Greece.
| | - Anastasios Christodoulou
- First Orthopaedic Department of Aristotelian University of Thessaloniki, "G. Papanikolaou" General Hospital, 57010, Exohi, Thessaloniki, Greece. . . .
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Mansat P, Nouaille Degorce H, Bonnevialle N, Demezon H, Fabre T. Total elbow arthroplasty for acute distal humeral fractures in patients over 65 years old - results of a multicenter study in 87 patients. Orthop Traumatol Surg Res 2013; 99:779-84. [PMID: 24095596 DOI: 10.1016/j.otsr.2013.08.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Fractures of the distal humerus represent 5% of osteoporosis fragility fractures in subjects over the age of 60. Osteoporosis, comorbidities and intra-articular comminution make management of this entity difficult. HYPOTHESIS The hypothesis was that total elbow arthroplasty could be a reliable treatment option in subjects over the age of 65 presenting with a fracture of the distal humerus. MATERIALS AND METHODS Eight-seven patients (80 women and 7 men) mean age 79 years old (65-93) underwent total elbow arthroplasty for the treatment of an AO type A fracture in 9 cases, type B in 8 and type C in 70. RESULTS After a mean follow-up of 37.5 months (6-106) the Mayo Elbow Performance Score MEPS was 86±14, the quick-DASH score was 24±19 and the Katz score was 5±1.5 points. The MEPS was better in patients with a high preoperative Katz score and a history of inflammatory arthritis who were living at home. Fifty-five patients (63%) presented with a pain-free elbow, and 20 (24%) with slight pain. The flexion-extension range of motion was 97±22° and 48% presented with a flexion-extension arc of at least 100°. Function was normal in 69 patients. Complications were identified in 20 cases (23%) and revision surgery was necessary in 8 (9%). Two arthroplasties had to be changed, one for a fracture of the humeral stem component and the other for loosening. Only one infection occurred in this series. CONCLUSION Total elbow arthroplasties provide fractured patients with immediate satisfactory results and a stable, painless and functional elbow. These results seem to be reliable and durable. The rate of complications is low with revision surgery in approximately 10%. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- P Mansat
- Service d'orthopédie-traumatologie, institut de l'appareil locomoteur, CHU Purpan, place du Dr-Baylac, 31059 Toulouse, France.
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Partial distal humeral resurfacing of a trochlear defect after elbow fracture-dislocation. J Shoulder Elbow Surg 2013; 22:e7-11. [PMID: 23352480 DOI: 10.1016/j.jse.2012.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Revised: 08/28/2012] [Accepted: 09/17/2012] [Indexed: 02/01/2023]
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Abstract
Management of coronal shear fractures of the distal humerus has evolved considerably over the past 3 decades, with an increased appreciation of the complexity of these fractures, improvements in internal fixation techniques, and the use of more extensile exposures. Nearly all of these fractures are displaced, given the paucity of soft tissue attachments and correspondingly, nonsurgical management is fraught with complications including chronic pain, mechanical symptoms, and instability and is not recommended. Good to excellent outcomes can be achieved in the majority of patients with open reduction internal fixation, particularly when the fracture is limited to the radiocapitellar joint. Outcomes are worst for those with considerable medial extension or comminution. Computed tomography is highly recommended to guide surgical planning. The presence of posterior comminution or extension to the medial column might require more extensile exposures and supplemental fixation for adequate stability. Arthroscopic reduction and fixation techniques have been described for the simple fracture. Those not amenable to fixation might do better with total elbow arthroplasty in a select population. Long-term data demonstrate the durability of these elbows following open reduction internal fixation. Complications other than stiffness are rare. Radiographic avascular necrosis does not appear to affect outcome. Radiographic mild to moderate arthritis was observed in half of patients at 17-year follow-up.
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Affiliation(s)
- John J Lee
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109-5328, USA.
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Adolfsson L, Nestorson J. The Kudo humeral component as primary hemiarthroplasty in distal humeral fractures. J Shoulder Elbow Surg 2012; 21:451-5. [PMID: 22005125 DOI: 10.1016/j.jse.2011.07.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Revised: 06/30/2011] [Accepted: 07/10/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND Treatment of intra-articular fractures of the distal humerus in the elderly is challenging. In patients with very distal fractures and severe comminution, primary arthroplasty has been advocated. Recently, a few reports have described promising results of hemiarthroplasty. This study describes the medium-term results of using the Kudo humeral implant (Biomet Ltd, Bridgend, U.K.) as replacement of the distal humerus. MATERIAL AND METHODS Eight women (mean age, 79 years) were treated. Follow-up was conducted at a mean of 4 years after the procedure and consisted of the Mayo Elbow Performance Score (MEPS), radiographic images, and range of motion (ROM). RESULTS All patients had a good or excellent outcome according to the MEPS. Mean ROM was 31° to 126°. Radiographic signs of attrition of the ulna were observed in 3 patients but did not correlate with the functional outcome. A periprosthetic fracture occurred in 1 patient 3 years after the index operation, and ROM was unsatisfactory in 1 patient. No other complications were observed. CONCLUSION The use of the Kudo humeral implant as a hemiarthroplasty resulted in a reasonable functional outcome in the medium-term, but the radiographic signs of attrition suggest that the implant is not recommended as a hemiprosthesis.
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Affiliation(s)
- Lars Adolfsson
- Department of Orthopaedics, Linköping University Hospital, Linköping, Sweden.
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Sanchez-Sotelo J. Distal humeral fractures: role of internal fixation and elbow arthroplasty. J Bone Joint Surg Am 2012; 94:555-68. [PMID: 22438005 DOI: 10.2106/jbjs.946icl] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Joaquin Sanchez-Sotelo
- Department of Orthopaedic Surgery, Gonda 14, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Distal Humerus Hemiarthroplasty of the Elbow for Comminuted Distal Humeral Fractures in the Elderly Patient. ACTA ACUST UNITED AC 2011; 71:635-42. [DOI: 10.1097/ta.0b013e318216936e] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Hemiarthroplasty involves replacement of the distal portion of the humerus without replacement of the ulna. This article reviews the literature on hemiarthroplasty of the ulnohumeral and radiocapitellar joints. It discusses the indications and outcomes of the technique and summarizes the author's experiences and results.
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Affiliation(s)
- Scott P Steinmann
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
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Mehlhoff TL, Bennett JB. Distal humeral fractures: fixation versus arthroplasty. J Shoulder Elbow Surg 2011; 20:S97-106. [PMID: 21281926 DOI: 10.1016/j.jse.2010.11.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 11/12/2010] [Accepted: 11/12/2010] [Indexed: 02/01/2023]
Affiliation(s)
- Thomas L Mehlhoff
- Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX 77030-4509, USA.
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Burkhart* KJ, Müller* LP, Schwarz C, Mattyasovszky SG, Rommens PM. Behandlung der komplexen intraartikulären Fraktur des distalen Humerus mittels Latitude-Ellenbogenprothese. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2010; 22:279-98. [DOI: 10.1007/s00064-010-8031-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Management of distal humerus fractures continues to challenge orthopaedic surgeons. The unique and complex anatomy of the distal humerus, involving the ulnohumeral and radiocapitellar joints, makes anatomic reduction difficult and hardware placement challenging. However, long-term results of well-performed open reduction and internal fixation demonstrate satisfactory outcomes in most patients. Osteoporosis in the elderly population often leads to severe comminution, which may render open reduction and internal fixation impossible. Total elbow arthroplasty in the elderly has become a viable option, with excellent results in the properly selected patient who understands the lifetime limitations of this option. Distal humeral replacement is a new and potentially exciting option but it is currently not approved by the US Food and Drug Administration and has no long-term follow-up to support its use.
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Charissoux JL, Mabit C, Fourastier J, Beccari R, Emily S, Cappelli M, Malingue E, Mansat P, Hubert L, Proust J, Bratu D, Veillard D, Grandmaison FLD, Apard T, Martinel V, Bonnevialle N. Fractures articulaires complexes de l’extrémité distale de l’humérus chez le sujet âgé. ACTA ACUST UNITED AC 2008; 94:S36-62. [DOI: 10.1016/j.rco.2008.03.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kalogrianitis S, Sinopidis C, El Meligy M, Rawal A, Frostick SP. Unlinked elbow arthroplasty as primary treatment for fractures of the distal humerus. J Shoulder Elbow Surg 2008; 17:287-92. [PMID: 18178487 DOI: 10.1016/j.jse.2007.06.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2006] [Revised: 06/01/2007] [Accepted: 06/07/2007] [Indexed: 02/01/2023]
Abstract
This study reviews our experience with primary total elbow arthroplasty in the management of acute distal humeral fractures by use of the iBP unlinked elbow prosthesis. We followed up 9 elbows in 9 patients (including 2 with rheumatoid arthritis), with a mean age of 73 years, for a mean of 3.5 years. Functional outcome was assessed with the Mayo Elbow Performance Score and the recently developed Liverpool Elbow Score. Clinical examination and radiologic assessment were performed by an independent surgeon. All elbows were stable at the latest follow-up examination, all patients were able to perform daily activities, and pain relief was satisfactory. The median value for the Mayo Elbow Performance Score was 95 (range, 65-100). This is the first report of the use of an unlinked prosthesis for the treatment of distal humeral fractures. Our results show that this method of treatment provides a reliable and effective way of dealing with these very difficult fractures when internal fixation is not a viable option.
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