Complex fractures of the distal humerus in the elderly: primary total elbow arthroplasty or open reduction and internal fixation? Mid-term follow-up.
Aged
Aged, 80 and over
Arthroplasty, Replacement, Elbow
/ adverse effects
Elbow
Elbow Joint
/ diagnostic imaging
Female
Follow-Up Studies
Fracture Fixation, Internal
/ adverse effects
Humans
Humeral Fractures
/ diagnostic imaging
Humerus
Range of Motion, Articular
Retrospective Studies
Treatment Outcome
Distal humeral fracture
Elbow fracture
Elderly
Open reduction–internal fixation
Osteoporotic fracture
Osteosynthesis
Periarticular fracture
Upper extremity fracture
Journal
International orthopaedics
ISSN: 1432-5195
Titre abrégé: Int Orthop
Pays: Germany
ID NLM: 7705431
Informations de publication
Date de publication:
08 2021
08 2021
Historique:
received:
31
01
2021
accepted:
29
03
2021
pubmed:
14
4
2021
medline:
18
9
2021
entrez:
13
4
2021
Statut:
ppublish
Résumé
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. 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. 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. 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.
Identifiants
pubmed: 33846847
doi: 10.1007/s00264-021-05027-z
pii: 10.1007/s00264-021-05027-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2103-2110Informations de copyright
© 2021. SICOT aisbl.
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