Complex Fractures of the Distal Humerus in the Elderly: Primary Total Elbow Arthroplasty or Open Reduction and Internal Fixation? Mid-term Follow-up

Overview

Journal Int Orthop

Specialty Orthopedics

Date 2021 Apr 13

PMID 33846847

Citations 3

Authors

Yaiza Lopiz

Daniel Garriguez-Perez

Carlos Garcia-Fernandez

Laura Del Bano

Maria Galan-Olleros

Fernando Marco

Affiliations

Soon will be listed here.

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.

Citing Articles

A systematic review of the treatment of distal humerus fractures in older adults: A comparison of surgical and non-surgical options.

Stoddart M, Panagopoulos G, Craig R, Falworth M, Butt D, Rudge W Shoulder Elbow. 2024; 16(2):175-185.

PMID: 38655404 PMC: 11034469. DOI: 10.1177/17585732221099845.

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.

Seok H, Park J, Park S J Clin Med. 2022; 11(19).

PMID: 36233648 PMC: 9571352. DOI: 10.3390/jcm11195775.

Combined use of minimal screw synthesis and external articulated fixation is effective for the management of supra-intercondyloid humeral fractures in the elderly? A retrospective study.

Bienati F, Isola A, Ortu S, Bonini L, Sirianni R, Capone A J Orthop. 2022; 34:331-338.

PMID: 36210959 PMC: 9535269. DOI: 10.1016/j.jor.2022.09.011.

References

Frankle M, Herscovici Jr D, DiPasquale T, Vasey M, Sanders R . 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(7):473-80. DOI: 10.1097/00005131-200308000-00001. View

Lovy A, Keswani A, Koehler S, Kim J, Hausman M . Short-Term Complications of Distal Humerus Fractures in Elderly Patients: Open Reduction Internal Fixation Versus Total Elbow Arthroplasty. Geriatr Orthop Surg Rehabil. 2016; 7(1):39-44. PMC: 4748166. DOI: 10.1177/2151458516630030. View

Goyal N, Bohl D, Ong K, Lau E, Nicholson G, Wysocki R . Reoperation Risk After Total Elbow Arthroplasty Versus Open Reduction Internal Fixation for Distal Humerus Fractures in Elderly Patients. J Orthop Trauma. 2020; 34(9):503-509. DOI: 10.1097/BOT.0000000000001767. View

Varecka T, Myeroff C . Distal Humerus Fractures in the Elderly Population. J Am Acad Orthop Surg. 2017; 25(10):673-683. DOI: 10.5435/JAAOS-D-15-00683. View

Chalidis B, Dimitriou C, Papadopoulos P, Petsatodis G, Giannoudis P . Total elbow arthroplasty for the treatment of insufficient distal humeral fractures. A retrospective clinical study and review of the literature. Injury. 2009; 40(6):582-90. DOI: 10.1016/j.injury.2009.01.123. View

Baksi D, Pal A, Baksi D . Prosthetic replacement of elbow for intercondylar fractures (recent or ununited) of humerus in the elderly. Int Orthop. 2010; 35(8):1171-7. PMC: 3167422. DOI: 10.1007/s00264-010-1122-5. View

Ducrot G, Ehlinger M, Adam P, Di Marco A, Clavert P, Bonnomet F . Complex fractures of the distal humerus in the elderly: is primary total elbow arthroplasty a valid treatment alternative? A series of 20 cases. Orthop Traumatol Surg Res. 2013; 99(1):10-20. DOI: 10.1016/j.otsr.2012.10.010. View

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(7):779-84. DOI: 10.1016/j.otsr.2013.08.003. View

Linn M, Gardner M, McAndrew C, Gallagher B, Ricci W . Is primary total elbow arthroplasty safe for the treatment of open intra-articular distal humerus fractures?. Injury. 2014; 45(11):1747-51. PMC: 4321717. DOI: 10.1016/j.injury.2014.07.017. View

10.

Sorensen B, Brorson S, Olsen B . Primary total elbow arthroplasty in complex fractures of the distal humerus. World J Orthop. 2014; 5(3):368-72. PMC: 4095031. DOI: 10.5312/wjo.v5.i3.368. View

11.

Barco R, Streubel P, Morrey B, Sanchez-Sotelo J . Total Elbow Arthroplasty for Distal Humeral Fractures: A Ten-Year-Minimum Follow-up Study. J Bone Joint Surg Am. 2017; 99(18):1524-1531. DOI: 10.2106/JBJS.16.01222. View

12.

Lami D, Chivot M, Caubere A, Galland A, Argenson J . First-line management of distal humerus fracture by total elbow arthroplasty in geriatric traumatology: Results in a 21-patient series at a minimum 2years' follow-up. Orthop Traumatol Surg Res. 2017; 103(6):891-897. DOI: 10.1016/j.otsr.2017.06.009. View

13.

Antuna S, Barco Laakso R, Barrera J, Espiga X, Ferreres A . Linked total elbow arthroplasty as treatment of distal humerus fractures. Acta Orthop Belg. 2012; 78(4):465-72. View

14.

Kholinne E, Altamimi L, Aldayel A, Alsabti R, Kim H, Park D . Primary Linked Total Elbow Arthroplasty for Acute Distal Humerus Fracture Management: A Systematic Review of Clinical Outcome. Clin Orthop Surg. 2020; 12(4):503-513. PMC: 7683186. DOI: 10.4055/cios20012. View

15.

Kamineni S, Morrey B . Distal humeral fractures treated with noncustom total elbow replacement. J Bone Joint Surg Am. 2004; 86(5):940-7. DOI: 10.2106/00004623-200405000-00009. View

16.

Prasad N, Ali A, Stanley D . Total elbow arthroplasty for non-rheumatoid patients with a fracture of the distal humerus: a minimum ten-year follow-up. Bone Joint J. 2016; 98-B(3):381-6. DOI: 10.1302/0301-620X.98B3.35508. View

17.

Pogliacomi F, Schiavi P, Defilippo M, Corradi M, Vaienti E, Ceccarelli F . Total elbow arthroplasty following complex fractures of the distal humerus: results in patients over 65 years of age. Acta Biomed. 2016; 87(2):148-55. View

18.

Korner J, Lill H, Muller L, Hessmann M, Kopf K, Goldhahn J . Distal humerus fractures in elderly patients: results after open reduction and internal fixation. Osteoporos Int. 2004; 16 Suppl 2:S73-9. DOI: 10.1007/s00198-004-1764-5. View

19.

Huang J, Paczas M, Hoyen H, Vallier H . Functional outcome after open reduction internal fixation of intra-articular fractures of the distal humerus in the elderly. J Orthop Trauma. 2011; 25(5):259-65. DOI: 10.1097/BOT.0b013e3181dfd348. View

20.

Serrano-Mateo L, Lopiz Y, Leon-Serrano C, Garcia-Fernandez C, Lopez-Duran-Stern L, Marco F . [Results after internal fixation of humerus distal fractures in patients over than 65 years old]. Rev Esp Cir Ortop Traumatol. 2013; 58(1):31-7. DOI: 10.1016/j.recot.2013.09.008. View