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http://dx.doi.org/10.5397/cise.2020.00052

Comparison of open reduction and internal fixation with total elbow arthroplasty for intra-articular distal humeral fractures in older age: a retrospective study  

Baik, Jong Seok (Department of Orthopedic Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine)
Lee, Sung Hyun (Department of Orthopedic Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine)
Kang, Hyun Tak (Department of Orthopedic Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine)
Song, Tae Hyun (Department of Orthopedic Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine)
Kim, Jeong Woo (Department of Orthopedic Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine)
Publication Information
Clinics in Shoulder and Elbow / v.23, no.2, 2020 , pp. 94-99 More about this Journal
Abstract
Background: Intra-articular distal humeral fractures can be surgically challenging. It remains under discussion whether open reduction and internal fixation (ORIF) or total elbow arthroplasty (TEA) is more beneficial for treatment of the elderly. This study aimed to compare the clinical and functional outcomes of ORIF and TEA for managing intra-articular distal humerus fractures in patients aged 65 years or older. Methods: Patients who underwent ORIF (n=28) or TEA (n=43) for in intra-articular distal humerus fracture between May 2008 and December 2018 were reviewed. Range of motion, Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder, and Hand (DASH) score, radiologic outcomes, and surgical complications were evaluated at the final follow-up visit. Results: The ORIF and TEA groups showed a mean arc of flexion-extension of 97°±21° and 101°±12°, respectively. The mean MEPS and DASH scores were 94±15 and 27±12 points, respectively, in the ORIF group and 81±27 and 47±28 points in the TEA group. This difference was statistically significant. The incidence of total complications was similar between the groups. Conclusions: In patients older than 65 years with intra-articular distal humerus fracture, ORIF had better outcomes than TEA.
Keywords
Fracture fixation; Total elbow replacement; Humeral fracture; Aged, 65 and over; Treatment outcome;
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1 Robinson CM, Hill RM, Jacobs N, Dall G, Court-Brown CM. Adult distal humeral metaphyseal fractures: epidemiology and results of treatment. J Orthop Trauma 2003;17:38-47.   DOI
2 Zalavras CG, Vercillo MT, Jun BJ, Otarodifard K, Itamura JM, Lee TQ. Biomechanical evaluation of parallel versus orthogonal plate fixation of intra-articular distal humerus fractures. J Shoulder Elbow Surg 2011;20:12-20.   DOI
3 Shin SJ, Sohn HS, Do NH. A clinical comparison of two different double plating methods for intraarticular distal humerus fractures. J Shoulder Elbow Surg 2010;19:2-9.   DOI
4 Hackl M, Wegmann K, Bartsch V, Ries C, Burkhart KJ, Muller LP. Impingement of the posterolateral humeral plate: landmarks for prevention in double-plate osteosynthesis of distal humeral fractures. Obere Extremitat 2014;9:186-91.   DOI
5 Korner J, Lill H, Muller LP, et al. Distal humerus fractures in elderly patients: results after open reduction and internal fixation. Osteoporos Int 2005;16:S73-9.   DOI
6 McKee MD, Wilson TL, Winston L, Schemitsch EH, Richards RR. Functional outcome following surgical treatment of intra-articular distal humeral fractures through a posterior approach. J Bone Joint Surg Am 2000;82:1701-7.   DOI
7 McKee MD, Jupiter JB. Fractures of the distal humerus. In: Browner B, Jupiter J, Levine A, Trafton P, eds. Skeletal trauma. 3rd ed. Philadelphia, PA: Lippincott; 2002. p. 765-82.
8 O'Driscoll SW. Optimizing stability in distal humeral fracture fixation. J Shoulder Elbow Surg 2005;14 Suppl S:186S-194S.   DOI
9 Sodergard J, Sandelin J, Bostman O. Postoperative complications of distal humeral fractures. 27/96 adults followed up for 6 (2-10) years. Acta Orthop Scand 1992;63:85-9.   DOI
10 Korner J, Lill H, Muller LP, Rommens PM, Schneider E, Linke B. The LCP-concept in the operative treatment of distal humerus fractures: biological, biomechanical and surgical aspects. Injury 2003;34 Suppl 2:B20-30.
11 McKee MD, Pugh DM, Richards RR, Pedersen E, Jones C, Schemitsch EH. Effect of humeral condylar resection on strength and functional outcome after semiconstrained total elbow arthroplasty. J Bone Joint Surg Am 2003; 85:802-7.   DOI
12 Morrey BF, Adams RA, Bryan RS. Total replacement for post-traumatic arthritis of the elbow. J Bone Joint Surg Br 1991;73:607-12.   DOI
13 Morrey BF, Adams RA. Semiconstrained elbow replacement for distal humeral nonunion. J Bone Joint Surg Br 1995;77:67-72.   DOI
14 Fracture and dislocation compendium: Orthopaedic Trauma Association Committee for Coding and Classification. J Orthop Trauma 1996;10 Suppl 1:v-ix. 1-154.
15 Armstrong AD, Yamaguchi K. Total elbow anthroplasty and distal humerus elbow fractures. Hand Clin 2004;20:475-83.   DOI
16 John H, Rosso R, Neff U, Bodoky A, Regazzoni P, Harder F. Operative treatment of distal humeral fractures in the elderly. J Bone Joint Surg Br 1994;76:793-6.
17 Jupiter JB, Neff U, Holzach P, Allgower M. Intercondylar fractures of the humerus. An operative approach. J Bone Joint Surg Am 1985;67:226-39.   DOI
18 Morrey BF, Chao E, Cooney W, et al. Indications in patient selection. In: Morrey BF, ed. Joint replacement arthroplasty. New York, NY: Churchill Livingstone; 1991. p. 275-91.
19 Gambirasio R, Riand N, Stern R, Hoffmeyer P. Total elbow arthroplasty as primary treatment for distal humeral fractures in elderly patients. J Bone Joint Surg Br 2001; 83:974-78.   DOI
20 Garcia JA, Mykula R, Stanley D. Complex fractures of the distal humerus in the elderly: the role of total elbow replacement as primary treatment. J Bone Joint Surg Br 2002;84:812-6.   DOI
21 Frankle MA, Herscovici D Jr, DiPasquale TG, Vasey MB, Sanders RW. A comparison of open reduction and internal fixation and primary total elbow arthroplasty in the treatment of intraarticular distal humerus fractures in women older than age 65. J Orthop Trauma 2003;17:473-80.   DOI
22 McKee MD, Veillette CJ, Hall JA, et al. A multicenter, prospective, randomized, controlled trial of open reduction--internal fixation versus total elbow arthroplasty for displaced intra-articular distal humeral fractures in elderly patients. J Shoulder Elbow Surg 2009;18:3-12.   DOI
23 Egol KA, Tsai P, Vazques O, Tejwani NC. Comparison of functional outcomes of total elbow arthroplasty vs plate fixation for distal humerus fractures in osteoporotic elbows. Am J Orthop (Belle Mead NJ) 2011;40:67-71.
24 Obremskey WT, Bhandari M, Dirschl DR, Shemitsch E. Internal fixation versus arthroplasty of comminuted fractures of the distal humerus. J Orthop Trauma 2003;17:463-5.   DOI
25 Savvidou OD, Zampeli F, Koutsouradis P, et al. Complications of open reduction and internal fixation of distal humerus fractures. EFORT Open Rev 2018;3:558-67.   DOI