Megaprosthetic Replacement in Complex Distal Humerus Fractures in Elderly Patients: a Case Series

Overview

Journal J Orthop Surg Res

Publisher Biomed Central

Specialty Orthopedics

Date 2024 Jan 11

PMID 38212796

Authors

Matteo Caredda

Luigi Cianni

Andrea De Fazio

Antonio Ziranu

Raffaele Vitiello

Giulio Maccauro

Affiliations

Soon will be listed here.

Abstract

Background: Managing distal humeral fractures can be challenging for orthopedic surgeons. There are several treatment options for managing this type of fracture, and the treatment method for these fractures should be based on patient-related factors. In elderly patients with osteoporotic bone and severe comminution of the fracture, adequate fixation can be a major challenge for surgeons. The use of megaprosthesis has been recently proposed in traumatology as an alternative to osteosynthesis or conventional prosthesis for the management of comminuted articular fractures in elderly patients with poor bone stock.

Methods: A consecutive case series of 5 patients who underwent reconstruction of the elbow joint with a trabecular hinged modular elbow megaprosthesis was reviewed retrospectively. All patients included had AO/OTA 13C2 and 13C3 fractures with metaphyseal extension and considerable bone loss of the distal humerus. The primary outcome was the evaluation of functional and clinical outcomes with the MEPS score in comminuted distal humerus fractures with metaphyseal extension and poor bone stock in elderly patients treated with elbow megaprosthesis. The secondary outcome was assessing the treatment-related complication rate of this technique in non-oncological fields.

Results: Five patients were included in the study with a mean age of 82.66 ± 7.72 years at surgery. The mean MEPS value was 63 ± 24.2 at 1 month, 81 ± 23.53 at 3 months, 83 ± 24.2 at 6 months, and 84 ± 24.57 at 12 months. No intraoperative complications were recorded in our series. Of 5 patients, four patients had excellent clinical and functional outcomes. We did not encounter wound dehiscence, prosthetic joint infection, aseptic loosening, or periprosthetic fractures.

Conclusions: The indication for this type of treatment must be selected and narrowed down, as it is a salvage procedure, and any failure would cause even more complex situations. Short operating times and early mobilization of the elbow are the advantages of this technique.

Citing Articles

Elbow Reconstruction with Megaprosthesis: An Effective Strategy for Salvage Surgery in Trauma Patients.

Dragosloveanu S, Petre M, Gherghe M, Baz R, Cergan R, Scheau C Diagnostics (Basel). 2024; 14(7).

PMID: 38611636 PMC: 11011899. DOI: 10.3390/diagnostics14070724.

Functional and Rehabilitative Outcomes of Patients Affected by Bone Cancer of the Upper Limb Treated with MUTARS Prosthesis: A Narrative Review.

Codazza S, Ferrara P, Aprovitola A, Ariani M, La Cagnina F, Coraci D J Clin Med. 2024; 13(6).

PMID: 38541876 PMC: 10970860. DOI: 10.3390/jcm13061651.

References

Funovics P, Schuh R, Adams Jr S, Sabeti-Aschraf M, Dominkus M, Kotz R . Modular prosthetic reconstruction of major bone defects of the distal end of the humerus. J Bone Joint Surg Am. 2011; 93(11):1064-74. DOI: 10.2106/JBJS.J.00239. View

Lundh F, Sayed-Noor A, Brosjo O, Bauer H . Megaprosthetic reconstruction for periprosthetic or highly comminuted fractures of the hip and knee. Eur J Orthop Surg Traumatol. 2013; 24(4):553-7. DOI: 10.1007/s00590-013-1237-7. View

Piccioli A, Donati F, Giacomo G, Ziranu A, Careri S, Spinelli M . Infective complications in tumour endoprostheses implanted after pathological fracture of the limbs. Injury. 2016; 47 Suppl 4:S22-S28. DOI: 10.1016/j.injury.2016.07.054. View

Ziranu A, Lillo M, Fantoni M, Maffulli N, Maccauro G . Single dose cefazolin is safe and effective for pre-operative prophylaxis in orthopaedic oncology. J Biol Regul Homeost Agents. 2019; 32(6 Suppl. 1):45-49. View

Morrey M, Morrey B, Sanchez-Sotelo J, Barlow J, ODriscoll S . A review of the surgical management of distal humerus fractures and nonunions: From fixation to arthroplasty. J Clin Orthop Trauma. 2021; 20:101477. PMC: 8237363. DOI: 10.1016/j.jcot.2021.101477. View

Loisel F, Amar Y, Rochet S, Obert L . Distal humerus fracture in older patients: ORIF vs. total elbow arthroplasty. Orthop Traumatol Surg Res. 2023; 110(1S):103759. DOI: 10.1016/j.otsr.2023.103759. View

Moghaddam-Alvandi A, Dremel E, Guven F, Heppert V, Wagner C, Studier-Fischer S . [Arthrodesis of the elbow joint. Indications, surgical technique and clinical results]. Unfallchirurg. 2010; 113(4):300-7. DOI: 10.1007/s00113-009-1722-y. View

Koller H, Kolb K, Assuncao A, Kolb W, Holz U . The fate of elbow arthrodesis: indications, techniques, and outcome in fourteen patients. J Shoulder Elbow Surg. 2007; 17(2):293-306. DOI: 10.1016/j.jse.2007.06.008. View

Martin S, Sanchez E . Anatomy and biomechanics of the elbow joint. Semin Musculoskelet Radiol. 2013; 17(5):429-36. DOI: 10.1055/s-0033-1361587. View

10.

McKee M, Veillette C, Hall J, Schemitsch E, Wild L, McCormack R . 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. 2008; 18(1):3-12. DOI: 10.1016/j.jse.2008.06.005. View

11.

Desloges W, Faber K, King G, Athwal G . Functional outcomes of distal humeral fractures managed nonoperatively in medically unwell and lower-demand elderly patients. J Shoulder Elbow Surg. 2015; 24(8):1187-96. DOI: 10.1016/j.jse.2015.05.032. View

12.

Graham T, Fitzgerald M . The destroyed elbow. Am J Orthop (Belle Mead NJ). 2000; 29(9 Suppl):9-15. View

13.

Ziranu A, Bocchi M, Oliva M, Meschini C, Messina F, Calori S . Survivorship of proximal femoral replacement in neoplastic and non-neoplastic elderly patients. Eur Rev Med Pharmacol Sci. 2022; 26(1 Suppl):106-112. DOI: 10.26355/eurrev_202211_30289. View

14.

Capanna R, Muratori F, Campo F, DArienzo A, Frenos F, Beltrami G . Modular megaprosthesis reconstruction for oncological and non-oncological resection of the elbow joint. Injury. 2016; 47 Suppl 4:S78-S83. DOI: 10.1016/j.injury.2016.07.041. View

15.

El Ezzo O, Oliva M, Cauteruccio M, Saracco M, Vitiello R, Maccauro G . Innovations in prevention of infections in oncological megaprostheses: a narrative review. J Biol Regul Homeost Agents. 2020; 34(4 Suppl. 3). View

16.

Trung D, Tran Q, Tu N, Quang S, Nguyen Huu M, Trung H . Non-oncologic indication for elbow megaprothesis replacement: 2 cases report. Int J Surg Case Rep. 2021; 86:106356. PMC: 8430374. DOI: 10.1016/j.ijscr.2021.106356. View

17.

Agha R, Sohrabi C, Mathew G, Franchi T, Kerwan A, ONeill N . The PROCESS 2020 Guideline: Updating Consensus Preferred Reporting Of CasESeries in Surgery (PROCESS) Guidelines. Int J Surg. 2020; 84:231-235. DOI: 10.1016/j.ijsu.2020.11.005. View

18.

Mehlhoff T, Bennett J . Distal humeral fractures: fixation versus arthroplasty. J Shoulder Elbow Surg. 2011; 20(2 Suppl):S97-106. DOI: 10.1016/j.jse.2010.11.012. View

19.

Vitiello R, Matrangolo M, El Motassime A, Perna A, Cianni L, Maccauro G . Three-Dimension-Printed Custom-Made Prosthetic Reconstructions in Bone Tumors: A Single Center Experience. Curr Oncol. 2022; 29(7):4566-4577. PMC: 9322169. DOI: 10.3390/curroncol29070361. View

20.

Nauth A, McKee M, Ristevski B, Hall J, Schemitsch E . Distal humeral fractures in adults. J Bone Joint Surg Am. 2011; 93(7):686-700. DOI: 10.2106/JBJS.J.00845. View