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Palladino S, Baldairon F, Godet J, Clavert P. Outcomes of total elbow arthroplasty in the treatment of distal humeral fractures in the elderly: a retrospective cohort comparison between primary arthroplasty and arthroplasty secondary to failed internal fixation. J Shoulder Elbow Surg 2024; 33:1659-1664. [PMID: 38710364 DOI: 10.1016/j.jse.2024.03.032] [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: 10/09/2023] [Revised: 03/05/2024] [Accepted: 03/11/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND The primary objective of this study was to compare the clinical outcomes of total elbow arthroplasty as the index procedure in the treatment of traumatic distal humerus fractures with those of secondary total elbow arthroplasty after failed internal fixation. The secondary objective was to compare the complication rates and the radiographic results in the 2 groups. Our hypothesis was that the clinical results of total elbow arthroplasty performed after failed internal fixation were comparable to those of primary total elbow arthroplasty in the treatment of distal humerus fractures in the elderly population. METHODS We conducted a retrospective cohort comparison study, including 60 patients with a median age of 80 years (71-85 years), who either underwent a primary total elbow arthroplasty (group 1; 45 patients) or secondary total elbow arthroplasty after failed internal fixation (group 2; 15 patients) in the treatment of a post-traumatic supra and intercondylar fracture of the distal humerus, between January 2004 and January 2021. The clinical examination, including the Mayo Elbow Performance Score and triceps proficiency test, complication rates, and the need for reoperation were noted. The average clinical and radiographic follow-up was 40.8 months (24-120 months). RESULTS The clinical results of the 2 groups were comparable when looking at the Mayo Elbow Performance Score (90.00 [85.00, 100.00], P = .486). With regard to complications, there were 2 surgical site infections in group 1 and 3 in group 2 (P = .099), 1 case of mechanical loosening of the humeral component in group 1 and 1 in group 2 (P = .448), and 1 patient with triceps insufficiency in group 1. CONCLUSIONS Secondary total elbow arthroplasty after failed internal fixation has shown good functional results and a complication rate comparable to that of index total elbow arthroplasty in the treatment of articular fractures of the distal humerus in the elderly.
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Affiliation(s)
- Stefano Palladino
- Upper Limb Surgery Department, Hôpital de Hautepierre 2, Strasbourg University Hospital, Strasbourg, France.
| | - Florent Baldairon
- Upper Limb Surgery Department, Hôpital de Hautepierre 2, Strasbourg University Hospital, Strasbourg, France
| | - Julien Godet
- Public Health Department, Strasbourg University Hospital, Strasbourg, France
| | - Philippe Clavert
- Upper Limb Surgery Department, Hôpital de Hautepierre 2, Strasbourg University Hospital, Strasbourg, France
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Donato DP, Simpson AM, Willcockson J, Veith J, King BW, Agarwal JP. Associations with Discharge to Post-Acute Care Facilities Among Patients Undergoing Open Reduction Internal Fixation of Distal Radius Fractures. Plast Surg (Oakv) 2024; 32:40-46. [PMID: 38433790 PMCID: PMC10902480 DOI: 10.1177/22925503221085082] [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: 03/05/2024] Open
Abstract
Introduction: Distal radius fractures are a common injury of the hand and wrist that often require intensive rehabilitation. We sought to identify risk factors associated with discharge to a post-acute care facility following distal radius fracture repair. Methods: The 2011 to 2016 National Surgical Quality Improvement Program® (NSQIP) database was queried for all Current Procedural Terminology (CPT) codes that corresponded with open distal radius fracture repair. Patients with concomitant traumatic injuries were excluded. Patient demographics, comorbidities, perioperative factors, laboratory data, and surgical details were collected. Our primary outcome was to determine postoperative discharge destination: home versus a post-acute care facility, and to identify factors that predict discharge to post-acute care facility. Secondary outcomes included unplanned readmission, reoperation, and complications. Results: Between 2011 and 2016, a total of 12,001 patients underwent open distal radius fracture repair and had complete information for their discharge. Of these analyzed patients, 3.24% (n = 389) were discharged to rehabilitation facilities. The following factors were identified on multivariate analysis to have an association with discharge to a post-acute care facility: 65 years or older, White race, underweight, using steroids preoperatively, American Society of Anesthesiologists (ASA) classification > 2, admitted from a nursing home or already hospitalized, anemic, undergoing bilateral surgery, wound classification other than clean, and complications prior to discharge. Conclusion: Factors identified by our study to have associations with discharge to post-acute care facilities following distal radius fracture repair can help in appropriate patient counseling and triage from the hospital to home versus a post-acute care facility.
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Affiliation(s)
- Daniel P Donato
- Division of Plastic and Reconstructive Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Andrew M Simpson
- Division of Plastic Surgery, Western University, London, ON, Canada
| | - James Willcockson
- Division of Plastic and Reconstructive Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jacob Veith
- Division of Plastic and Reconstructive Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Brody W King
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jayant P Agarwal
- Division of Plastic and Reconstructive Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
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Loisel F, Amar Y, Rochet S, Obert L. Distal humerus fracture in older patients: ORIF vs. total elbow arthroplasty. Orthop Traumatol Surg Res 2024; 110:103759. [PMID: 37992865 DOI: 10.1016/j.otsr.2023.103759] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 06/16/2023] [Indexed: 11/24/2023]
Abstract
Distal humerus fractures are a contemporary problem because the life expectancy, autonomy and functional demands of older patients continue to grow. This is combined with surgical advances in bone reconstruction, especially in fragile patients. A distal humerus fracture in an older adult is a serious injury with an uncertain prognosis. In fact, damage to the elbow joint in this complex anatomical area overwhelmed by low-quality bone occurs in patients who often have unfavorable characteristics (fragile skin, low physiological reserves, organ failure) combined with pharmaceutical treatments that can be iatrogenic. The treatment indication must not be based solely on the conventional radiographs used for classification purposes; the fracture and bone quality must be analyzed in three dimensions. Also, the surgeon must understand the patient's needs, worries and risks fully to decide between conservative treatment and anatomical locking plate fixation or elbow arthroplasty (hemi or total). In the end, the chosen treatment must allow at least 100̊ and preferably 120̊ of flexion-extension at the elbow. In this age range, the choice between arthroplasty and plate fixation is definitive; the surgical approach must make it possible to carry out either option, with arthroplasty implants available in case the trochlear fracture cannot be plated. The aim of this lecture is to provide a fresh perspective on the anatomy of the distal humerus, its fracture and the best surgical approaches, discuss how to decide on the indication, outline the safest and most reliable ways to reconstruct and stabilize the elbow, and lastly, summarize the expected outcomes and potential complications of each treatment option. Level of evidence: V; expert opinion.
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Affiliation(s)
- François Loisel
- Department of Orthopedic, Trauma, Plastic, Reconstructive and Hand Surgery, EA Laboratoire de Nano médecine Imagerie Thérapeutique (LNIT), CHRU of Besançon & CIC IT, 808, boulevard Fleming, 25033 Besançon, France
| | - Yassine Amar
- Department of Orthopedic, Trauma, Plastic, Reconstructive and Hand Surgery, EA Laboratoire de Nano médecine Imagerie Thérapeutique (LNIT), CHRU of Besançon & CIC IT, 808, boulevard Fleming, 25033 Besançon, France
| | - Severin Rochet
- Department of Orthopedic, Trauma, Plastic, Reconstructive and Hand Surgery, EA Laboratoire de Nano médecine Imagerie Thérapeutique (LNIT), CHRU of Besançon & CIC IT, 808, boulevard Fleming, 25033 Besançon, France
| | - Laurent Obert
- Department of Orthopedic, Trauma, Plastic, Reconstructive and Hand Surgery, EA Laboratoire de Nano médecine Imagerie Thérapeutique (LNIT), CHRU of Besançon & CIC IT, 808, boulevard Fleming, 25033 Besançon, France.
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Liu C, Zhang D, Blazar P, Earp BE. Outcomes After Acute Versus Delayed Total Elbow Arthroplasty for the Treatment of Distal Humerus Fractures. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:612-619. [PMID: 37790826 PMCID: PMC10543816 DOI: 10.1016/j.jhsg.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/07/2023] [Indexed: 10/05/2023] Open
Abstract
Purpose Compare outcomes of acute versus delayed total elbow arthroplasty (TEA) following distal humerus fractures (DHF). Methods This retrospective study included 39 patients who underwent primary TEA with semiconstrained implants for DHF, either within 4 weeks of their injury or after failing initial open reduction and internal fixation (ORIF) or nonsurgical management, between June 1, 2003 and February 1, 2018 with minimum 1-year follow-up. Our outcome measures included QuickDASH (Disabilities of the Arm, Shoulder, and Hand) score, complications, reoperations, and range of motion (ROM). Demographics, clinical variables, and outcomes were compared using the Student's t-test, Mann-Whitney U test, and Fisher's exact test as appropriate. Kaplan-Meier curves for mortality, implant survivorship, and reoperation were created. Results Our patients were categorized into acute TEA (n = 22), ORIF to TEA (n = 10), and nonsurgical to TEA (n = 7) treatment groups. Additional analysis was performed comparing acute to delayed TEA, which combined data from failed ORIF and nonsurgical cohorts. The median follow-up, average age, and median Charlson comorbility index were similar between groups. The most common fracture pattern was AO13C. At median follow-up of 5.8 years, QuickDASH differed between cohorts: mean of 31 (SD 19) in acute TEA and 52 (SD 27) in delayed TEA, which further subdivided to 44.2 (SD 25) in failed ORIF and 76 (SD 23) in failed nonsurgical management. Poorer QuickDASH scores at final follow-up were associated with delayed TEA, initial nonsurgical management, and depression. Surgical complications were associated with delayed TEA. Higher Charlson comorbidity index was associated with death. No variables were associated significantly with ROM, revision, or reoperation. Conclusion Comminuted DHFs are difficult to treat in the elderly with high rates of complication and poor function after surgery. Our study suggests TEA performed acutely result in satisfactory outcomes and should be a consideration for patients at high risk of failing ORIF or nonsurgical management. Type of Study/Level of Evidence Therapeutic, III.
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Affiliation(s)
- Christina Liu
- Division of Hand and Upper-Extremity Surgery, Department of Orthopedics, Brigham and Women’s Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Dafang Zhang
- Division of Hand and Upper-Extremity Surgery, Department of Orthopedics, Brigham and Women’s Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Philip Blazar
- Division of Hand and Upper-Extremity Surgery, Department of Orthopedics, Brigham and Women’s Hospital, Boston
- Harvard Medical School, Boston, MA
| | - Brandon E. Earp
- Division of Hand and Upper-Extremity Surgery, Department of Orthopedics, Brigham and Women’s Hospital, Boston
- Harvard Medical School, Boston, MA
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Dündar A. Bicolumnar 90-90 Locking Plate Fixation Through a Posterior Approach for the Treatment of Low Distal Humeral Fracture in Elderly Patients. Cureus 2023; 15:e40123. [PMID: 37425567 PMCID: PMC10329422 DOI: 10.7759/cureus.40123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 07/11/2023] Open
Abstract
Background and objective Treating transcondylar humeral fractures in elderly individuals remains a challenge in trauma surgery, with plate fixation being one potential treatment method. This retrospective study was conducted to assess the effectiveness of plate fixing through a posterior approach in elderly individuals suffering from distal humeral fractures. Methods This retrospective study involved 28 older participants aged ≥65 years with low transcondylar fractures of the humerus (AO/OTA 13A2-3 fractures). We used the 90-90 orthogonal method for treatment. The inclusion criteria were as follows: (1) low transcondylar type of distal humeral fractures (13A2-3 according to the AO/OTA classification system), (2) patients aged ≥65 years, and (3) a follow-up period of at least 12 months. The exclusion criteria were as follows: polytrauma, pathological injuries, chronic elbow osteoarthritis or degenerative arthropathy, and fractures impacting the articular surface of the distal humeral. Clinical outcomes were assessed in terms of the visual analog scale (VAS) score, Mayo Elbow Performance Score (MEPS), and range of motion (ROM) of the elbow joint. Results The mean age of the patients was 72.25 years (range: 65-81 years), of which 14 (50%) were female and 14 (50%) were male. The mean VAS score for pain was 2.7 (range: 0-6). The mean angle of flexion was 130.6o (range: 115-140o), and the mean angle of the extension was -27.7 (range: -21 to -34). Regarding MEPS, 23 patients had an excellent score, four patients had a good score, and one patient had a poor score. There were four complications (two major and two minor) in the patients involved in the study. Conclusion Based on our findings, 90-90 plate fixation for low distal humeral fractures is associated with a high union rate and satisfactory clinical outcomes. Although we found complications in four patients, their healing was not affected. Therefore, we concluded that through improved monitoring and care, we could overcome such complications, and they did not affect the healing of the bone.
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Affiliation(s)
- Abdulrahim Dündar
- Department of Orthopedics and Traumatology, Hitit University Erol Olçok Training and Research Hospital, Çorum, TUR
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Fouladpour A, Asadi K, Aris A, Mollaei A, Vajargah PG, Karkhah S, Salari A. Massive bone defects due to infection at the surgical site associated with a distal humeral fracture that was treated using fibula autograft: a case report. Ann Med Surg (Lond) 2023; 85:955-959. [PMID: 37113880 PMCID: PMC10129282 DOI: 10.1097/ms9.0000000000000183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 12/24/2022] [Indexed: 03/31/2023] Open
Abstract
Distal humerus fractures comprise between 2 and 5% of all fractures, and approximately one-third of all humerus fractures are of this type. In the present report, the authors described the massive bone defects due to infection at the surgical site associated with a distal humeral fracture that was treated using fibula autograft. Case presentation A 28-year-old female patient experienced a fall from a height of 4 m and was referred to Poursina Educational and Medical Center. Clinical examinations and radiological imaging showed an open fracture of the right distal humerus. In the postoperative 50-day follow-up, the complication of infection at the surgical site causes bone loss of up to 8 cm. The posterior triceps-split approach (Campbell) to the distal humerus was used in this surgery. To evaluate the quality of surgery, standard radiographs of anteroposterior and lateral of the elbow joint and humeral shaft were performed after surgery. Clinical discussion At 5 months postoperatively, the patient's initial results are good, and the range of motion of the elbow joint is ~10-120°. Conclusion Based on the results of the present study, fibular transplantation in distal humerus fractures is considered one of the bone treatment options for repair.
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Affiliation(s)
- Amin Fouladpour
- Department of Orthopedics, Orthopedic Research Center, Poorsina Hospital, Faculty of Medicine, Guilan University of Medical Sciences
| | - Kamran Asadi
- Department of Orthopedics, Orthopedic Research Center, Poorsina Hospital, Faculty of Medicine, Guilan University of Medical Sciences
| | - Arash Aris
- Department of Orthopedics, Orthopedic Research Center, Poorsina Hospital, Faculty of Medicine, Guilan University of Medical Sciences
| | - Amirabbas Mollaei
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Pooyan Ghorbani Vajargah
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Samad Karkhah
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Amir Salari
- Department of Orthopedics, Orthopedic Research Center, Poorsina Hospital, Faculty of Medicine, Guilan University of Medical Sciences
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Low Transcondylar Fractures of the Distal Humerus: A Multicenter Cohort Study. J Orthop Trauma 2023; 37:e57-e62. [PMID: 36084238 DOI: 10.1097/bot.0000000000002486] [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] [Accepted: 08/31/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine the demographic characteristics and clinical and radiologic results of low transcondylar fractures and compare them with those of other types of distal humerus fractures using multicenter data and to suggest an optimal method for their treatment. DESIGN Retrospective cohort study. SETTING Tertiary-care university hospital. PATIENTS Between 2009 and 2019, 581 patients who underwent surgery for distal humerus fractures (OTA/AO classification A1 to C3) were enrolled at 7 university-affiliated hospitals. INTERVENTION Internal fixation of low transcondylar fractures. MAIN OUTCOME MEASURES Demographic characteristics, including sex, age, mechanism of injury, fixation methods, and complications, were compared between low transcondylar (group A) and other distal humerus (group B) fractures. Clinical outcomes assessed included pain, stability, and range of motion. Radiographs obtained at the latest follow-up were assessed for union, delayed union, nonunion, and implant failure. RESULTS Mean age was 62.1 ± 19.1 (range, 20-95) years, and it was higher in group A (n = 100) than in group B (n = 376). Patients in group A were predominantly women. Low-energy trauma, such as that from a simple fall, was the most common cause of fracture in group A. Both column fixation, including parallel and orthogonal double plating, was performed more commonly in group A than in group B (87.4% vs. 66.4%, P < 0.001). The nonunion rate was higher in group A, but the difference was not significant. The incidence of ulnar nerve-related symptoms was higher in group A after surgery (6.3% vs. 2.0%, P = 0.003). No significant difference in clinical outcomes was found between the groups. CONCLUSIONS Low transcondylar fractures occurred more frequently than other distal humerus fractures in older female patients and accounted for 21% of distal humerus fractures. The incidence of ulnar nerve-related symptoms was higher in patients with low transcondylar fractures after surgery. Clinical outcomes were not inferior in patients with low transcondylar fractures. The nonunion rate in patients with low transcondylar fractures treated with double plating was 3.6%. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Comparison of the Complications, Reoperations, and Clinical Outcomes between Open Reduction and Internal Fixation and Total Elbow Arthroplasty for Distal Humeral Fractures in the Elderly: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11195775. [PMID: 36233648 PMCID: PMC9571352 DOI: 10.3390/jcm11195775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
Distal humeral fractures are challenging injuries seen in the elderly. Open reduction and internal fixation (ORIF) are the gold standard treatments. Total elbow arthroplasty (TEA) is an alternative to ORIF. This study aimed to pool and analyze the outcomes and complications in elderly patients with distal humeral fractures treated with either ORIF or TEA by performing a meta-analysis. We searched the PubMed, Embase, Google Scholar, and Cochrane Library databases for studies that compared the clinical and functional outcomes of ORIF and TEA in patients aged 60 years or older. After screening and performing a quality assessment of the articles, we obtained one randomized control study and nine retrospective comparative studies. The odds ratio and standardized mean difference were used to analyze the differences in outcomes between the two surgical options. In terms of the flexion/extension arc, TEA produced significantly better outcomes than ORIF (p = 0.02). The rates of reoperation and elbow stiffness were significantly lower in the TEA group than in the ORIF group (p = 0.003 and p = 0.04, respectively). However, the functional scores and other ranges of motion (flexion, loss of extension, pronation, supination) after surgery were similar between the two groups. The outcomes from the present meta-analysis can provide guidance when selecting a surgical option for distal humeral fractures in the elderly.
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Park SG, Seok HG. Bi-columnar locking plate fixation through a combined medial and lateral approach for the treatment of low transcondylar fractures of the distal humerus in the elderly. BMC Musculoskelet Disord 2022; 23:764. [PMID: 35948886 PMCID: PMC9367132 DOI: 10.1186/s12891-022-05594-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Low transcondylar fractures (LTFs) of the distal humerus are relatively uncommon elbow injuries in elderly patients after low-energy injuries. Although there is still debate regarding the method of fixation, several surgeons prefer bi-columnar fixation using pre-contoured locking plates. However, posterior approaches, which are usually used to perform the above procedure, have disadvantages, such as ulnar nerve neuropathy, damage to the extensor mechanism, and the need for general anesthesia. To solve these problems, the authors designed a combined medial and lateral approach. The purpose of this study was to present the outcomes of bi-columnar internal fixation through a combined medial and lateral approach for the treatment of LTFs of the distal humerus in the elderly. Methods A total of 46 patients diagnosed with distal humeral fractures between May 2017 and April 2020 were included. Thirty patients were excluded, and 16 patients who underwent open reduction and internal fixation by the medial and lateral approach were selected. We carried out all the surgeries under brachial plexus anesthesia. The clinical outcomes were assessed based on the visual analog scale (VAS) score, Mayo elbow performance score (MEPS), disabilities of the arm, shoulder, and hand (DASH) score, and range of motion (ROM) of the elbow joint. Standardized radiographs were obtained at 3, 6, and 12 months after surgery and at the last follow-up visit to evaluate for bony union and to check for complications, such as ulnar nerve neuropathy and heterotopic ossification. Results The mean age was 81 years (range, 65–91 years). Bony union was achieved in 15 out of 16 patients. The mean VAS score was 2.1 (range, 0–6), the mean MEPS was 84.4 (range, 70–100), and the mean DASH score was 20.6 (range, 9.5–33.6). There were three complications including reduction loss, skin necrosis, and stiffness of the elbow. There was no ulnar nerve neuropathy. The post-operative ROM was 100 degrees or higher in all cases, which did not cause any impairment in daily life. Conclusion LTFs of the distal humerus in the elderly can yield satisfactory results with bi-columnar internal fixation through a combined medial and lateral approach.
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Affiliation(s)
- Sam-Guk Park
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Yeungnam University Hospital, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu, 42415, Korea.
| | - Hyun-Gyu Seok
- Department of Orthopedic Surgery, Yeungnam University Medical Center, Yeungnam University Hospital, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu, 42415, Korea
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Abstract
Approximately 4.1% of all fractures in the elderly involve the elbow. Most elbow injuries in geriatric patients occur as the result of low-energy mechanisms such as falls from standing height. Elbow injuries in elderly patients present complex challenges because of insufficient bone quality, comminution, articular fragmentation, and preexisting conditions, such as arthritis. Medical comorbidities and baseline level of function must be heavily considered in surgical decision making.
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Affiliation(s)
- Naoko Onizuka
- Department of Orthopaedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN 55455, USA; Department of Orthopaedic Surgery, Methodist Hospital, 6500 Excelsior Boulevard, Saint Louis Park, MN 55426, USA
| | - Julie Switzer
- Department of Orthopaedic Surgery, University of Minnesota, 2512 South 7th Street, Suite R200, Minneapolis, MN 55455, USA; Department of Orthopaedic Surgery, Methodist Hospital, 6500 Excelsior Boulevard, Saint Louis Park, MN 55426, USA
| | - Chad Myeroff
- TRIA Orthopedic Center, 155 Radio Drive, Woodbury, MN 55125, USA.
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Tomori Y, Nanno M, Sonoki K, Majima T. Surgical outcomes of coronal shear fractures of the distal humerus in the elderly. J NIPPON MED SCH 2021; 89:81-87. [PMID: 34526454 DOI: 10.1272/jnms.jnms.2022_89-202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The purpose of this study is to evaluate the clinical outcomes of the elderly with coronal shear fractures (CSFs) of the distal humerus who had undergone open reduction and internal fixation (ORIF). METHODS Between April 2002 and March 2019, eight elderly patients (76.3 ± 5.1 years)with CSFs of the distal humerus were investigated retrospectively. Postoperative complications, the range of motion (ROM) of the elbow joint, and functional elbow scoring (Mayo elbow performance score; MEPS) were assessed. RESULTS The mean follow-up duration was 23.6 ± 13.9 months. CSFs were treated by a buried implantable headless screw or Kirshner wires or bioresorbable screw with/without lateral locking plates. There were no superficial or deep infections, or elbow joint instability. Seven patients obtained fracture healing, but one patient showed non-union. Osteochondritis dissecans was present in one patient. Three patients showed step-off deformity (> 2 mm) of the articular surface. Two patients displayed a collapse of the fractured articular surface. A patient with severe comminution of both the capitellum and the trochlear showed the collapse of the whole articular surface with osteonecrosis of the capitellum and trochlea. Mean the range of motion of the elbow were flexion, 116.3±12.7° and extension, -28.8±14.1°. The mean MEPS was 78.8±10.2 points, representing patients who scored an excellent (n=1), good (n=3), and fair (n=4). CONCLUSION ORIF yielded satisfactory outcomes for theelderly with noncomminuted CSF of the distal humerus. However, the cases with comminuted articular fragment or complex posterior fractures were still challenging.
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Affiliation(s)
- Yuji Tomori
- Department of Orthopaedic Surgery, Nippon Medical School Hospital
| | - Mitsuhiko Nanno
- Department of Orthopaedic Surgery, Nippon Medical School Hospital
| | - Kentaro Sonoki
- Department of Orthopaedic Surgery, Nippon Medical School Hospital
| | - Tokifumi Majima
- Department of Orthopaedic Surgery, Nippon Medical School Hospital
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Complex fractures of the distal humerus in the elderly: primary total elbow arthroplasty or open reduction and internal fixation? Mid-term follow-up. INTERNATIONAL ORTHOPAEDICS 2021; 45:2103-2110. [PMID: 33846847 DOI: 10.1007/s00264-021-05027-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare the mid-term outcomes in intra-articular distal humerus fracture (AO/OTA type C) treated with either open reduction-internal fixation (ORIF) or total elbow arthroplasty (TEA) in patients older than 75 years and with more than five years of follow-up. METHODS Retrospective study including 24 patients (11 TEA vs. 13 ORIF) with a mean age of 82 years and being all females. Results assessed included (1) radiographic measures; (2) functional results: range of motion, Mayo Elbow Performance Score (MEPS), quick-DASH; and (3) complications. RESULTS TEA group vs. ORIF group achieved a mean flexion of 117° ± 9.6° vs. 106° ± 14°, extension loss of 38° ± 17° vs. 30.8° ± 16°, pronation 75° ± 5° vs. 85° ± 7° and supination 75° ± 4° vs. 70° ± 5°. Mean MEPS score was 71.6 vs. 83.6 (p = .183) and mean quick-DASH was 44.8 vs. 42.6 (p = .789). All 13 patients in the ORIF group demonstrated radiographic signs of bone union and none underwent conversion to TEA. Sixty-three percent of the patients in the TEA group underwent re-operation at an average of 72 months (62.4-75.2 months), including three for periprosthetic fracture and four for implant loosening. Whereas in the ORIF group, 23% of the patients were re-operated upon excluding olecranon osteotomy hardware, two for stiffness, and one for an olecranon tension band wire failure. CONCLUSIONS Although there were no differences in mid-term functional outcomes between either treatment, our results suggest that the recent trend towards the use of TEA instead of ORIF in the elderly should be re-examined due to the high rate of complications beyond five years of follow-up with TEA.
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Abstract
Background Distal humerus fracture open reduction and internal fixation (ORIF) represents a substantial cost burden to the health care system. The purpose of this study was to describe surgical encounter cost variation for distal humerus ORIF, and to determine demographic-, injury-, and treatment-specific factors that influence cost. Methods We retrospectively identified adult patients (≥18 years) treated for isolated distal humerus fractures between July 2014 and July 2019 at a single tertiary academic referral center. For each case, surgical encounter total direct costs (SETDCs) were obtained via our institution's information technology value tools, which prospectively record granular direct cost data for every health care encounter. Costs were converted to 2019 dollars using the personal consumption expenditure indices for health and summarized with descriptive statistics. Univariate and multivariate linear regression models were used to identify factors influencing SETDC. Results Surgical costs varied widely for the 47 included patients, with a standard deviation (SD) of 33% and interquartile range of 76%-124% relative to the mean SETDC. Implant and facility costs were responsible for 46.2% and 32.6% of the SETDC, respectively. Implant costs also varied considerably, with an SD of 21% and range from 13%-36% relative to the mean SETDC. Multivariate analysis demonstrated that SETDC increased 24% (P < .001) on performing an olecranon osteotomy, and by 15% for each additional 1 hour of surgical time (P < .001). These findings were independent of age, sex, body mass index, open fracture, need for an additional small plate construct as a reduction aid, and fracture pattern (all insignificant in the multivariate analysis, with P >.05 for each factor). Conclusion Substantial variations in surgical encounter total direct costs for distal humerus ORIF exist, as do wide variations in associated implant costs that comprise nearly half of the entire surgical cost. Performing an olecranon osteotomy, and increased surgical time, significantly increased surgical costs. Although use of an olecranon osteotomy may not be a completely controllable factor as it is confounded by fracture severity and operative time, this may suggest that surgeons should try to use an olecranon osteotomy judiciously. Although complexity of the fracture pattern was statistically insignificant, it is confounded by the need for an olecranon osteotomy and increased surgical time and likely is a clinically relevant and nonmodifiable driver of surgical cost. These findings highlight opportunities to reduce cost variation, and potentially improve the value of care, for distal humerus ORIF patients.
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Olson JJ, Dyer GS. Skinny wire and locking plate fixation for comminuted intra-articular distal humerus fractures: a technical trick and case series. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:34-40. [PMID: 37588629 PMCID: PMC10426594 DOI: 10.1016/j.xrrt.2020.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Introduction Intra-articular distal humerus fractures present a challenge to orthopedic surgeons. Stable fixation is difficult to achieve in fractures with articular and metaphyseal comminution and osteoporotic bone. Hence, these fractures are more commonly being managed with total elbow arthroplasty. We describe a novel surgical technique that confers stable fixation, allowing for early range of motion resulting in a high rate of union, a functional range of motion, and excellent patient reported outcome scores without the activity restrictions of total elbow arthroplasty. Methods Retrospective case series of 30 patients with AO/OTA type B and C intra-articular distal humerus fractures who underwent ORIF from 2014-2019 utilizing a novel surgical technique that focuses on reconstructing a comminuted articular surface through meticulous, transverse fixation of the tiny articular fragments with long, thin Kirchner wires, which are then bent over and trapped under locking compression plates to create a fixed angle support to the metadiaphysis. Results Patient mean age of 59 (19-90) years and 61% were female. Median follow up was 1.2 years. Twenty-seven (87%) were type C fractures and 3 (13%) were type B. Five patients (16%) suffered a concurrent ipsilateral upper extremity injury and four (13%) had an open fracture. Two were polytrauma patients. All fractures healed with an average time to union of 11 weeks. Over 80% patients reported no or mild pain at final follow up. Mean arc of elbow motion was 102 degrees, mean QuickDASH score 25.2. Post-operative complications included ulnar nerve paresthesias (38%), wound infection (3.2%), heterotopic ossification (3.2%), and olecranon nonunion (3.2%). Eight patients underwent secondary procedures: 7 (23%) removal hardware, 3(9.6%) capsular release, 2 (6.4%) ulnar nerve transpositions, and 1 (3.2%) total elbow arthroplasty. Conclusion We describe a novel surgical technique that we believe results in strong, stable fixation of complex intra-articular distal humerus fractures irrespective of bone quality. In our series, all fractures healed and post-operatively patients reported low levels of pain, achieved excellent elbow range of motion, high patient reported outcome scores. Patients should be counseled about high rates of post-operative ulnar nerve paresthesias that can be expected to improve over time and high reoperation rates for symptomatic hardware.
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Affiliation(s)
- Jeffrey J. Olson
- Harvard Combined Orthopaedic Surgery Program, Boston, MA, USA
- Orthopaedic Trauma Initiative at Harvard Medical School, Boston, MA, USA
| | - George S.M. Dyer
- Harvard Combined Orthopaedic Surgery Program, Boston, MA, USA
- Orthopaedic Trauma Initiative at Harvard Medical School, Boston, MA, USA
- Brigham and Women’s Hospital, Department of Orthopaedic Surgery, Boston, MA, USA
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15
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Sur YJ, Kim Y, Park HY. Results of plate fixation for transcondylar fracture of the distal humerus: a rare pattern of fractures. JSES Int 2020; 4:478-484. [PMID: 32939471 PMCID: PMC7478994 DOI: 10.1016/j.jseint.2020.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background The pattern of transcondylar fracture of the humerus is unique and the incidence rate is very low. Stable internal fixation may be difficult to achieve, and complications have been reported at a higher rate. The purpose was to report the outcomes of open reduction and internal fixation (ORIF) for transcondylar fractures of the humerus. Methods Seventeen patients were included between January 2014 and December 2017. ORIF was performed using anatomic distal humerus plates. Results were evaluated by range of motion, Mayo Elbow Performance Score (MEPS), and complications. We analyzed the results according to ulnar nerve transposition status and fixation pattern. Results The mean range of elbow motion was 117° flexion and 20° extension. The MEPS was excellent in 12, good in 3, fair in 1, and poor in 1. There were in total 5 cases of complications among 17 patients: 1 with nonunion, 1 with ulnar neuropathy, 2 with delayed union, and 1 with heterotopic ossification. The results according to ulna nerve transposition and fixation pattern showed no difference. Conclusions For reliable and good results, rigid fixation using anatomic plates and appropriate immobilization of the fracture site are key factors in the treatment. In our case series, the overall outcome was good and there were 2 major complications. The ORIF using anatomic plates can be a reliable treatment option for transcondylar humeral fractures.
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Affiliation(s)
- Yoo Joon Sur
- Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University, Gyeonggi-do, Republic of Korea
| | - Yoochang Kim
- Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University, Gyeonggi-do, Republic of Korea
| | - Ho Youn Park
- Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University, Gyeonggi-do, Republic of Korea
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16
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Kaiser PB, Newman ET, Haggerty C, Appleton PT, Wixted JJ, Weaver MJ, Rodriguez EK. A Limited Fixation, Olecranon Sparing Approach, for Management of Geriatric Intra-Articular Distal Humerus Fractures. Geriatr Orthop Surg Rehabil 2020; 11:2151459320950063. [PMID: 32864180 PMCID: PMC7430082 DOI: 10.1177/2151459320950063] [Citation(s) in RCA: 4] [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] [Indexed: 11/15/2022] Open
Abstract
Purpose We propose that geriatric comminuted intra-articular distal humerus fractures can be effectively treated with a limited fixation approach aimed at achieving varus/valgus stability with columnar fixation, but allowing intra-articular comminution to heal by secondary congruency against an intact olecranon, thus avoiding an olecranon osteotomy. Methods Fifty-six elderly patients with AO 13-C type fractures, who underwent surgical fixation with ≥12-months of follow-up were retrospectively reviewed. Thirty patients were treated with intra-articular open reduction internal fixation (ORIF) with an olecranon osteotomy and 26 patients were treated with our limited fixation (L-ORIF) approach. Outcomes were range of motion (ROM), complications, additional surgery, and patient-reported outcome measures (PROMIS). Results At final follow-up, the average elbow ROM was 97° (40°-155°) in the ORIF group and 86.5° (20°-145°) in the L-ORIF group. There was a trend toward more complications and additional surgery in the ORIF group. PROMIS scores for pain were 53.1 and 52.14, and PROMIS functional scores were 41.7 and 41.4 in the ORIF and L-ORIF group respectively. No differences in outcomes were statistically significant. Conclusion A limited fixation technique based on achieving varus/valgus stability with columnar fixation, demonstrated equivalent outcomes in elderly patients with intra-articular distal humerus fractures when compared to intra-articular ORIF with an olecranon osteotomy.
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Affiliation(s)
- Philip B Kaiser
- Harvard Combined Orthopaedic Residency Program, Boston, MA, USA
| | - Erik T Newman
- Harvard Combined Orthopaedic Residency Program, Boston, MA, USA
| | | | - Paul T Appleton
- Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA
| | - John J Wixted
- Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA
| | - Michael J Weaver
- Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | - Edward K Rodriguez
- Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA
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17
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Abstract
Distal humerus fractures in elderly patients are challenging due to poor bone quality and may threaten the independence of elderly patients due to loss of functional range of motion. Total elbow arthroplasty has gained popularity in the treatment of these injuries. This video demonstrates total elbow arthroplasty in an elderly patient with a comminuted distal humerus fracture.
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18
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Triceps-Sparing Total Elbow Arthroplasty for Distal Humerus Fracture: The Lateral Paraolecranon Approach. J Orthop Trauma 2020; 34 Suppl 2:S9-S10. [PMID: 32639338 DOI: 10.1097/bot.0000000000001830] [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] [Indexed: 02/02/2023]
Abstract
Distal humerus fractures in the elderly are a difficult problem to treat. Open reduction internal fixation has a high rate of complications, particularly because osteopenia compromises what is already tenuous fixation in a metaphyseal fracture. Total elbow arthroplasty is a more predictable outcome and easier recovery for these patients. However, most surgeons perform a low volume of total elbow arthroplasty. In addition, traditional exposure requires detachment of the triceps tendon. The lateral paraolecranon approach maintains the central tendon attachment to the olecranon while still facilitating relative ease of the procedure. Patients are allowed full active use of the triceps postoperatively, which is very helpful for polytrauma patients and those who are already dependent on assistive devices for ambulation.
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Abstract
The elbow joint consists of the humeroulnar, humeroradial, and proximal radioulnar joints. Elbow stability is maintained by a combination of static and dynamic constraints. Elbow fractures are challenging to treat because the articular surfaces must be restored perfectly and associated soft tissue injuries must be recognized and appropriately managed. Most elbow fractures are best treated operatively with restoration of normal bony anatomy and rigid internal fixation and repair and/or reconstruction of the collateral ligaments. Advanced imaging, improved understanding of the complex anatomy of the elbow joint, and improved fixation techniques have contributed to improved elbow fracture outcomes.
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Affiliation(s)
- Kaare S Midtgaard
- The Steadman Clinic, Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO 81657, USA; Oslo University Hospital, Division of Orthopaedic Surgery, Kirkeveien 166, Oslo 0450, Norway; Norwegian Armed Forces Joint Medical Services, Forsvarsvegen 75, Sessvollmoen 2058, Norway
| | - Joseph J Ruzbarsky
- The Steadman Clinic, Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO 81657, USA
| | - Thomas R Hackett
- The Steadman Clinic, Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO 81657, USA
| | - Randall W Viola
- The Steadman Clinic, Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO 81657, USA.
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20
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Wang X, Liu G. A comparison between perpendicular and parallel plating methods for distal humerus fractures: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2020; 99:e19602. [PMID: 32501964 PMCID: PMC7306383 DOI: 10.1097/md.0000000000019602] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To compare the clinical outcomes of perpendicular and parallel plating for the treatment of distal humerus fractures. METHODS Two investigators independently searched PubMed, OVID, and ScienceDirect databases prior to April 2019, without any limitations on language or publication status. The outcomes were union time, range of motion of elbow, Mayo Elbow Performance Score, and postoperative complications. Two authors independently performed a methodological quality and risk of bias assessment using Cochrane collaboration's tool. Data analysis was performed with STATA version 13.0. RESULTS Six randomized controlled trials with 305 participants were included. The present meta-analysis indicated that orthogonal plating was associated with a longer union time compared with parallel plating. There were no significant differences between the 2 groups regarding Elbow function, Mayo Elbow Performance Score, operation time, reduction quality, or postoperative complications. CONCLUSION Both parallel plating and orthogonal plating are considered to be effective methods when treating distal humerus fractures. The results of this study found that parallel plating is superior to orthogonal plating in humerus fracture healing.
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Affiliation(s)
- Xiaohan Wang
- Department of Orthopedics, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing
| | - Guoyan Liu
- Department of Orthopedics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Shandong, China
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21
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Patel SS, Mir HR, Horowitz E, Smith C, Ahmed AS, Downes K, Nydick JA. ORIF of Distal Humerus Fractures with Modern Pre-contoured Implants is Still Associated with a High Rate of Complications. Indian J Orthop 2020; 54:570-579. [PMID: 32850019 PMCID: PMC7429565 DOI: 10.1007/s43465-020-00124-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 04/15/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this study was to identify complications after operative treatment of distal humerus fractures with anatomic, pre-contoured, locking distal humeral plates. We hypothesized that these fractures have high complication rates despite the use of these modern implants. MATERIALS AND METHODS Between 2010 and 2018, 43 adult patients with a distal humerus fracture underwent open reduction and internal fixation (ORIF) at a Level I trauma center. Pre-operative variables, including medical comorbidities, mechanism of injury, open or closed fracture, AO/OTA fracture classification (Type A, B, or C), and nerve palsy, were recorded. Intra-operative variables including surgical approach, ulnar nerve transposition, and plate configuration were recorded. Anatomic, pre-contoured, locking distal humeral plates were used in all patients. Various plating systems were used based on surgeon preference and fracture pattern. Post-operative complications including infection, nonunion, malunion, painful implants, nerve palsy, heterotopic ossification, stiffness, and post-traumatic arthritis were recorded. RESULTS Most fractures were Type C (53%). The posterior olecranon osteotomy approach (51%) and parallel plate configuration (42%) were used in most cases. At a mean follow-up of 15 months, the complication rate was 61% (26/43 patients). Among all patients, 49% (21/43 patients) required a reoperation. Elbow stiffness (19%) was the most common complication followed by nerve palsy (16%). There were four fracture nonunions (9%), deep infections (9%), painful implants (9%), post-traumatic arthritis (9%), and heterotopic ossification (9%). CONCLUSIONS Distal humerus fractures treated with ORIF utilizing anatomic, pre-contoured, locking distal humeral plates have a high complication rate, with many requiring reoperation. LEVEL OF EVIDENCE Therapeutic Level IV.
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Affiliation(s)
- Shaan S. Patel
- Department of Orthopaedic Surgery, University of South Florida, 5 Tampa General Circle, HMT 710, Tampa, FL 33606 USA
| | - Hassan R. Mir
- Department of Orthopaedic Surgery, University of South Florida, 5 Tampa General Circle, HMT 710, Tampa, FL 33606 USA
- Florida Orthopaedic Institute, 13020 N Telecom Parkway, Tampa, FL 33637 USA
| | - Evan Horowitz
- Department of Orthopaedic Surgery, University of South Florida, 5 Tampa General Circle, HMT 710, Tampa, FL 33606 USA
| | - Carson Smith
- Department of Orthopaedic Surgery, University of South Florida, 5 Tampa General Circle, HMT 710, Tampa, FL 33606 USA
| | - Adil S. Ahmed
- Department of Orthopaedic Surgery, University of South Florida, 5 Tampa General Circle, HMT 710, Tampa, FL 33606 USA
| | - Katheryne Downes
- Florida Orthopaedic Institute, 13020 N Telecom Parkway, Tampa, FL 33637 USA
- Foundation for Orthopaedic Research and Education, 5 Tampa General Circle, HMT 710, Tampa, FL 33606 USA
| | - Jason A. Nydick
- Department of Orthopaedic Surgery, University of South Florida, 5 Tampa General Circle, HMT 710, Tampa, FL 33606 USA
- Florida Orthopaedic Institute, 13020 N Telecom Parkway, Tampa, FL 33637 USA
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Total Elbow Arthroplasty for Distal Humerus Fractures Provided Similar Outcomes When Performed as a Primary Procedure or After Failed Internal Fixation. J Orthop Trauma 2020; 34:95-101. [PMID: 31490269 DOI: 10.1097/bot.0000000000001631] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare clinical and functional outcomes of total elbow arthroplasty (TEA) for distal humerus fractures (DHF) performed either as a primary procedure or after internal fixation. DESIGN Retrospective, observational study. SETTING Mayo Clinic, Rochester, MN (1998 through 2016). PATIENTS/PARTICIPANTS Twenty-two TEA for acute DHF and 66 TEA after previous internal fixation. MAIN OUTCOME MEASUREMENTS Primary outcome measures included the Mayo Elbow Performance Score and motion. Reoperation rates and complications were also compared. RESULTS The mean time between internal fixation and arthroplasty was 7.3 years, and the main indications for conversion to TEA were nonunion (36%) and posttraumatic osteoarthritis (32%). There were female predominance (70%) and significant differences in age (74 years vs. 60 years, P < 0.0001) and tobacco use (0 vs. 23%; P = 0.02) between the primary and the salvage cohorts, respectively. Cohort demographics were otherwise comparable. TEA provided similar outcomes in both cohorts in terms of the Mayo Elbow Performance Score (acute 85, salvage 81, P = 0.32) and motion (acute 95/82/75 degrees, salvage 112/81/72 degrees in ulnohumeral/pronation/supination, P = 0.07/P = 0.85/P = 0.65). Reoperation rates were also similar (36% acute vs. 39% salvage, P = 1.00). Aseptic loosening (2 acute, 8 salvage) and deep infection (2 acute, 7 salvage) were the most common complications. CONCLUSIONS The clinical outcomes and reoperation rates of TEA for DHF seem to be similar when performed as a primary procedure or as salvage after previous internal fixation. The benefit of avoiding elbow arthroplasty in the acute setting needs to be balanced with the potential for 2 surgical procedures if internal fixation was to be unsuccessful. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Schindelar LE, Rondon AJ, Ilyas AM. Total Elbow Arthroplasty Versus Open Reduction and Internal Fixation for the Management of Distal Humerus Fractures in the Elderly. Orthopedics 2019; 42:22-27. [PMID: 30540876 DOI: 10.3928/01477447-20181206-05] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/13/2018] [Indexed: 02/03/2023]
Abstract
Distal humerus fractures, which are challenging injuries seen in geriatric patients, are often repaired using open reduction and internal fixation or total elbow arthroplasty. This updated meta-analysis, which includes more recent open reduction and internal fixation techniques, examined outcomes following distal humerus fractures repaired using open reduction and internal fixation vs total elbow arthroplasty. Although distal humerus fractures treated with total elbow arthroplasty achieved statistically higher functional scores relative to those treated with open reduction and internal fixation, this difference was not clinically significant. Furthermore, the authors found no early difference in the use of either open reduction and internal fixation or total elbow arthroplasty in the management of distal humerus fractures. Choice of treatment should be based on patients' long-term demands and anticipated need for implant longevity. [Orthopedics. 2019; 42(1):22-27.].
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