Outcomes of total elbow arthroplasty in the treatment of distal humeral fractures in the elderly: a retrospective cohort comparison between primary arthroplasty and arthroplasty secondary to failed internal fixation.

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Abstract

[Indexed for MEDLINE] 19. Rev Esp Cir Ortop Traumatol. 2014 Jan-Feb;58(1):31-7. doi: 10.1016/j.recot.2013.09.008. Epub 2013 Nov 8. [Results after internal fixation of humerus distal fractures in patients over than 65 years old]. [Article in Spanish] Serrano-Mateo L(1), Lopiz Y(2), León-Serrano C(2), García-Fernández C(2), López-Durán-Stern L(2), Marco F(2). Author information: (1)Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Clínico San Carlos, Madrid. España. Electronic address: l.serrano.mateo@gmail.com. (2)Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario Clínico San Carlos, Madrid. España. INTRODUCTION AND OBJECTIVE: Distal humerus fractures in the elderly frequently associated with poor bone quality and comminution, making it harder to achieve proper osteosynthesis. Our aim is to evaluate the radiological and functional results of open reduction and internal fixation of these fractures. MATERIAL AND METHODS: Retrospective study of 26 patients treated by open reduction and internal fixation between the years 2005-2010. Mean follow-up was 42 months. At final follow-up, a radiography evaluation (Knirk and Jupiter score) and clinical examination using Mayo Elbow Performance Score and Quick-Disabilities of the Arm, Shoulder and Hand Score was performed. Mean age of the group was 76.8 years (65-89), with 83% of the patients being female. Sixteen patients suffered type C fractures and 8 type A by AO classification. All underwent posterior surgical approach. RESULTS: Mean elbow flexion reached 118.86°, with a mean extension deficit of 25°. More than 3-quarters (79.1%) of the patients showed 0-1 grade degenerative changes on the X-ray films at final follow-up. Functional results reached an average 19.87 points on Quick-Disabilities of the Arm, Shoulder and Hand Score, and 85 points on Mayo Elbow Performance Score scores. Non-union occurred in 2 cases: distal humerus in one patient and olecranon osteotomy in another. Ulnar nerve neuropraxia was recorded in 2 cases, and radial nerve in one. All 3 recovered uneventfully. Revision surgery was required, with 2 patients needing hardware removal and one a new fixation. DISCUSSION: Treatment by open reduction and internal fixation with plating in elderly people for type A and C distal humerus fractures gives good functional results regarding this population, and thus scarcely disturbs their quality of life. Copyright © 2012 SECOT. Published by Elsevier Espana. All rights reserved. DOI: 10.1016/j.recot.2013.09.008