Is primary total elbow arthroplasty safe for the treatment of open intra-articular distal humerus fractures? (original) (raw)
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Total elbow anthroplasty and distal humerus elbow fractures
Hand Clinics, 2004
The indications for total elbow arthroplasty (TEA) have expanded over the last few decades. The initial primary indication for TEA was inflammatory arthritis of the elbow; however, more recently there have been reports on the successful use of TEA for other clinical situations, such as post-traumatic or primary osteoarthritis, nonunion or malunion of the distal humerus, and comminuted distal humerus fractures in elderly patients. As the indications for TEA have expanded, unfortunately the incidence of complications and implant failure also has increased. In 1994 Kraay et al reported their cumulative survival of TEA for post-traumatic arthritis, fractures, or supracondylar nonunion at 3 and 5 years compared with a second group of TEA in patients with inflammatory arthritis. The cumulative survival in the first group was 73% and 53% at 3 and 5 years, respectively, compared with 92% and 90% for the inflammatory group. This has raised concerns for expanding indications of TEA beyond patients with inflammatory arthritis. This article addresses the issues around TEA in the setting of comminuted distal humerus fractures in elderly patients and provides a review of the recent literature on this subject.
Acta bio-medica : Atenei Parmensis, 2016
BACKGROUND The treatment of complex distal humerus fractures is challenging and is often associated with unsatisfactory results. Anatomic reduction and stable internal fixation is difficult to obtain, especially in elderly osteoporotic patients. For these reasons, total elbow arthroplasty (TEA) has recently evolved as a valid procedure in selected cases following these injuries. The aim of this study was to analyze outcomes of TEA for the treatment of complex distal humerus fractures in 20 low-demanding patients over 65 years of age. MATERIALS AND METHODS All patients, at a mean follow-up of 60 months, were evaluated clinically using the Mayo Elbow Performance Score (MEPS) and radiographically in order to assess the positioning of the prosthetic components and signs of loosening. Statistical analyses investigated the presence of clinical and radiographic variables as predictive factors of poor functional outcomes. RESULTS Similar MEPSs were observed in the affected and unaffected ar...
Primary total elbow arthroplasty in complex fractures of the distal humerus
World journal of orthopedics, 2014
To evaluate short- to medium term outcome of total elbow arthroplasty (TEA) in complex fractures of the distal humerus. A consecutive series of 24 complex distal humerus fractures operated with TEA in the period 2006-2012 was evaluated with the Mayo Elbow Performance score (MEPS), plain radiographs, complications and overall satisfaction. The indications for surgery were 1: AO type B3 or C3 or Sheffield type 3 fracture and age above 65 or 2: fracture and severe rheumatoid arthritis. Mean follow-up time was 21 mo. Twenty patients were followed up. Four patients, of which 3 had died, were lost to follow up. According to the AO classification there were 17 C3, 1 B2 and 2 A2 fractures. Mean follow-up was 21 months (range 4-54). Mean MEPS was 94 (range 65-100). Mean flexion was 114 degrees (range 80-140). According to MEPS there were 15 excellent, 4 good and 1 fair result. Patient satisfaction: 8 excellent, 10 good, 2 fair and 1 poor. There were two revisions due to infection treated suc...
Background: Intra-articular distal humerus fractures comprise 1% of all fractures in adults1. Recent studies have emphasised the importance of surgical approach, rigid fixation and early rehabilitation for good outcome. Objectives: To assess the anatomical reduction of distal humeral articular surface by radiological examination and stability of the elbow by the functional assessment over a period of 1 year. Methodology: Thirty consecutive patients with distal humerus fractures were treated from October 2012 to October 2014 .The fractures were fixed using AO double column (orthogonal) plating techniques. Physiotherapy started from 3rd day post-op. Patients were followed at 6weeks, 3 months, 6 months, 1 year interval. Clinical outcome assessed using MEPI (Mayo Elbow Performance Index) score and radiologically assessed for reduction, alignment, fracture union, and complications. Results: All patients had completed postoperative physical therapy at the time of the study and had achieved maximum function of elbow. The mean duration of follow-up was 12 months. The mean arc of flexion was 106°. Mean pronation was 76° and supination was 77°. The mean MEPI score was 95.1 points (range 0 to 100 points), indicating mild impairment. Radiographic evidence of fracture union was noted in all patients. Conclusion: We conclude that internal fixation of intra-articular fractures of the distal humerus is an effective procedure with an excellent functional outcome in most patients. Patients have a high level of satisfaction and the majority return to their previous level of activity.
Linked total elbow arthroplasty as treatment of distal humerus fractures
Acta orthopaedica Belgica, 2012
Treatment of distal humerus fractures may be challenging, especially in the elderly patient. Total elbow replacement has been proposed as an option in selected patients. We present the results of a linked elbow replacement in 16 patients with a comminuted fracture of the distal humerus which was not considered amenable to reliable open reduction and internal fixation. At a mean follow-up of 57 months, average range of motion was from 28 degrees to 117 degrees of flexion-extension. Five patients with moderate to severe pain (31%) were not satisfied with the results of the operation. Three patients had an infection which resulted in implant removal in one patient. Eight patients had symptoms of sensory ulnar nerve neuropathy. Our results show that elbow replacement may be an optimal solution for highly comminuted osteoporotic fractures, if there are no associated complications. However, the rate of significant and minor complications such as infection or postoperative ulnar nerve symp...
Cureus, 2022
Introduction Treatment of intra-articular fractures of the distal humerus is challenging due to their complexity, comminution, and associated complications. The evolution of surgical approaches and the design of elbowspecific implants over the last decades have failed to improve clinical and radiological outcomes. Studies are sparse regarding the long-term influence of surgical treatment of these types of fractures in the upper limb function. The purpose of the current study was to retrospectively review the long-term functional outcome and complications of all intraarticular (AO type B, C) distal humerus fractures treated surgically in a university hospital during the last 25 years. Material and methods The study included patients who were surgically treated for an intra-articular distal humerus fracture between March 1991 and May 2016. Our initial search, using ICD-10 codes, identified 63 patients in the specific time period. Twelve patients had died, nine declined to participate, eight had emigrated, nine could not be located and one patient was excluded as he suffered from quadriplegia unrelated to the initial injury. The remaining 25 patients (mean age at surgery 44.2±19.67) were included in a follow-up study protocol. Functional outcome was evaluated according to Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), and the Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH). Pain was assessed using the Numerical Pain Rating Scale (NPRS) and subjects were asked to rate their satisfaction. Perioperative and late complications were recorded as well. Results The average follow-up was 158.16 ± 73.73 months. The average score was 89.4 ± 12.36 for MEPS, 42.68 ± 4.03 for OES, and 8.1 ± 15.38 for the QuickDASH. The patient satisfaction was rated 3.8 ± 1.08 on average. The mean flexion of the affected elbow was 137.6 ± 12.68 degrees while extension deficit was present in 14/25 patients, with a mean of 8.6 ± 8.96 degrees. We did not observe any mal-or non-unions. The re-operation rate was 32% primarily due to stiffness and irritation from the hardware. We noticed one spontaneously resolved ulnar nerve palsy, one combined radial, and ulnar nerve palsy after extensive arthrolysis that also resolved two cases of heterotopic ossification, one case of implant failure, and two cases of infection-one superficial, which was managed with antibiotics, and the other was deep managed with surgical drainage. Conclusions In our series, we found a satisfying range of motion, good functional outcome, and adequate ability to perform daily activities at a very long follow-up. Posttraumatic arthritis, whenever present, does not seriously affect functional performance.
Total Elbow Arthroplasty for Distal Humerus Fractures
Orthopedic Clinics of North America, 2013
Disclosures and Conflicts of Interest: The authors did not received payments or services, either directly or indirectly (ie, via their institution) from a third party in support of any aspect of this work. The authors' institution has had a financial relationship with entities in the biomedical arena (Zimmer and Tornier) that could be perceived to influence, or have the potential to influence, what is written in this work. The authors have had no other relationships or have engaged in no other activities that could be perceived to influence, or have the potential to influence, what is written in this work.
Distal Humeral Fractures Treated with Noncustom Total Elbow Replacement
Journal of Bone and Joint Surgery-american Volume, 2005
The purpose of this study was to review the cases of patients with a distal humeral fracture that was treated with a noncustom total elbow arthroplasty. We hypothesized that, on the basis of the functional and clinical outcome, total elbow replacement is a reliable option for the treatment of elderly patients with a severe, comminuted fracture of the distal part of the humerus. We retrospectively reviewed forty-nine acute distal humeral fractures in forty-eight patients who were treated with total elbow arthroplasty as the primary option. The average age of the patients was sixty-seven years. Forty-three fractures were followed for at least two years. According to the AO classification, five fractures were type A, five were type B, and thirty-three were type C. The average age of the forty-three patients was sixty-nine years and the average duration of follow-up was seven years. Fourteen patients died during the review period. Postoperative clinical function was assessed with use of the Mayo elbow performance score, and anteroposterior and lateral radiographs made at follow-up examinations were reviewed. At the latest follow-up examination, the average flexion arc was 24 degrees (range, 0 degrees to 75 degrees ) to 131 degrees (range, 100 degrees to 150 degrees ) and the Mayo elbow performance score averaged 93 of a possible 100 points. Heterotopic ossification was present to some extent in seven elbows, with radiographic abutment noted in two. Thirty-two (65%) of the forty-nine elbows had neither a complication nor any further surgery from the time of the index arthroplasty to the most recent follow-up evaluation. Fourteen elbows (29%) had a single complication, and most of them did not require further surgery. Ten additional procedures, including five revision arthroplasties, were required in nine elbows; five were related to soft tissue and five were related to the implant or bone. Complex distal humeral fractures should be assessed primarily for the reliability with which they can be reconstructed with osteosynthesis. When osteosynthesis is not considered to be feasible, especially in patients who are physiologically older and place lower demands on the joint, total elbow arthroplasty can be considered. This retrospective review supports a recommendation for total elbow arthroplasty for the treatment of an acute distal humeral fracture when strict inclusion criteria are observed.
Controversies in the management of intra-articular fractures of distal humerus in adults
Indian Journal of Orthopaedics, 2011
The surgical approach, type of olecranon osteotomy, method of stabilization of osteotomy, type of fracture stabilization, orthogonal vs parallel plate fixation, need for transposition of ulnar nerve, place for primary total elbow replacement, and type of rehabilitation schedule after surgical fracture treatment are the controversial issues in the treatment of complex intra-articular distal humerus fractures (C2 and C3) in adults. Severe comminution, bone loss, and osteoporosis at the site of distal articular fractures of humerus often lead to unsatisfactory results due to inadequate fixation. We hereby report the outcome of a series of intracondylar fractures of the humerus treated by open reduction and internal fixation and discuss the controversies in light of published literature. Materials and Methods: One hundred and eighty-four patients of intra-articular fractures of distal humerus (C2 and C3) were operated by posterior transolecranon approach between January 1980 and December 2008. Initially, in the first part Chevron intra-articular osteotomy (n=108) was performed out of which 94 have been published in another publication. In later second part (1993 onward), extra-articular olecranon osteotomy (n=76) was routinely performed. Both columns were stably fixed by orthogonal methods; (n=174) however, during the last 2 years, in 10 patients with severe comminution with bone loss, stabilization was achieved by parallel plating. The osteotomy was routinely stabilized by tension band wiring with two parallel K-wires introduced up to the anterior ulnar cortex. The results were evaluated by the staging system of Caja et al. at a minimum follow-up of 2 years. Results: In the first part of the study (n=94), there was delayed union in 4% (n=4), with the fracture taking more than 20 weeks for union. There was delayed union of ulnar osteotomy (n=3) and failure of one tension band wiring, requiring revision. Some loss of motion was seen in 20% of cases and these patients did not achieve full flexion and extension. However, all these patients had useful range of function, with 20°-110° of flexion and full pronation-supination. As per the staging system of Caja et al., the results were in the range of excellent to good in 72% cases (n=67), fair in 19% (n=18), and poor in 9% patients (n=9). In the second part of study (n=90) dual plate fixation of both columns by orthogonal methods (n=80) and parallel plate fixation in 10 patients was performed. The results were excellent to good in 78 patients (86%).