Total elbow arthroplasty in distal humerus fracture in patients older than 65 years.
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Published:
May 11, 2016
Keywords:
distal humeral fracture, supracondilar fracture, total elbow arthoplasty, older patients
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Abstract
ObjectiveTo report the clinical-functional results of the treatment of humeral distal fractures with a total elbow prosthesis in patients older than 65 years old.Material and methodsThis retrospective paper was performed in two surgical centers. Criteria inclusion were: patients with humeral distal fractures, > 65 years, operated on with Coonrad-Morrey prostheses, and with a follow-up of >1 year. Twenty-one patients were included. Twenty were women with an average age of 79 years old. According to AO classification, 13 fractures were type C3, 7 C2 and 1 A2. All patientes were operated on without desinsertion of the extensor mechanism. Average follow-up was 40 months.ResultsFlexo-extension was 123-17°, with a total arc of mobility of 106° (80 % of the contralateral side). Pain according to AVE was 1. The MEPI was 83 points: 8 patients had excellent results, 11 good, 1 regular and 1 bad. Average DASH score was 24 points.ConclusionTreatment of humeral distal fractures with total elbow arthoplasty in patients older than 65 years old, may lead to a good option of treatment, but indications must be limited to patients with complex fractures, bad bone quality, with osteoporosis and low functional demands.
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Gallucci, G., Calderón, W. L., Boretto, J., Castellaro Lantermo, J. A., Terán, J., & De Carli, P. (2016). Total elbow arthroplasty in distal humerus fracture in patients older than 65 years. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 81(2), 84-92. https://doi.org/10.15417/521
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Clinical Research
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References
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2. Robinson CM, Hill RM, Jacobs N, Dall G, Court-Brown C. Adult distal humeral metaphyseal fractures: epidemiology and results of treatment. J Orthop Trauma 2003;17:38-47.
3. Singer BR, McLauchlan GJ, Robinson CM, Christie J. Epidemiology of fractures in 15000 adults. J Bone Joint Surg Am 1998;80:243-8.
4. Rose SH, Melton LJ, Morrey BF, Ilstrup DM, Riggs BL. Epidemiologic features of humeral fractures. Clin Orthop1982;168:24-30.
5. Palvanen M, Kannus P, Niemi S, Parkkari J. Secular trends in distal humeral fractures of elderly women: nationwide statistics in Finland between 1970 and 2007. Bone. 2010 May;46(5):1355-8.
6. Diederichs G, Issever AS, Greiner S, Linke B, Korner J. Three-dimensional distribution of trabecular bone density and cortical thickness in the distal humerus. J Shoulder Elbow Surg 2009;18:399-407.
7. Morrey BF, Bryan RS, Dobyns JH, Linscheld RL. Total elbow arthroplasty. A five-year experience at the Mayo Clinic. J Bone Joint Surg Am 1981;63:1050-63.
8. Cobb TK, Morrey BF. Total elbow replacement arthroplasty primary treatment for distal humerus fractures in elderly patients. J Bone Joint Surg Am 1997;79:826-32
9. Hildebrand KA, Patterson SD, Regan WD, MacDermid JC, King GJ. Functional outcome of semiconstrained total elbow arthroplasty. J Bone Joint Surg Am 2000; 82:1379-86.
10. Gambirasio R, Riand N, Hoffmeyer P. Total elbow replacement for complex fractures of the distal humerus. An option for the elderly patient. J Bone Joint Surg Br 2001;83:974-8.
11. 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.
12. Frankle MA, Herscovici D, 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.
13. Prasad N, Dent C. Outcome of total elbow replacement for distal humeral fractures in the elderly. A comparison of primary surgery and surgery after failed internal fixation or conservative treatment. J Bone Joint Surg Br 2008;90:343-8.
14. Proust J, Oksman A, Charissoux JL, Mabit C, Arnaud JP. Results of internal fixation for intra-articular distal humerus fractures in elderly patients. Rev Chir Orthop 2007;93:798-806.
15. Gallucci GL, Gonzalez D, Boretto JG, Alfie VA, Donndorff A, De Carli P Artroplastia total del codo. Rev Asoc Argent Ortop Traumatol 2010;75(1):27-33.
16. Gallucci GL, Gonzalez D, Boretto JG, Alfie VA, Donndorff A, De Carli P Artroplastia total del codo posterior a una artritis séptica. Rev Asoc Argent Ortop Traumatol 2010;75(3):287-92.
17. Muller ME, Nazarian S. Comprehensive classification of fractures of long bones. Berlin: Springer Verlag; 1990.
18. Alonso-Llames M. Bilaterotricipital approach to the elbow. Its application in the osteosynthesis of supracondylar fractures of the humerus in children. Acta Orthop Scand 1972;43:479-90.
19. Morrey BF, An KN. Functional evaluation of the elbow. In: Morrey BF, editor. The elbow and its disorders. 2nd edition Philadelphia, PA: WB Saunders; 1993, 86-97.
20. Beaton DE, Katz JN, Fossel AH, Wright JG, Tarasuk V, Bombardier C. Measuring the whole or the parts? Validity,reliability, and responsiveness of the disabilities of the arm, shoulder and hand outcome measure in different regions of the upper extremity. J Hand Ther 2001;14:128-46.
21. Zagorski JB, Jennings JJ, Burkhalter WE, Uribe. Comminuted intraarticular fractures of the distal humeral condyles. Surgical vs. non-surgical treatment. Clin Orthop 1986;202: 197-204.
22. Helfet DL, Schmeling GJ. Bicondylarintraarticular fractures ofthe distal humerus in adults. Clin Orthop 1993;292:26-36.
23. Figgie MP, Inglis AE, Mow CS, Figgie 3rd HE. Salvage of nonunion of supracondylar fracture of the humerus by total elbow arthroplasty. J Bone Joint Surg Am 1989;71:1058—65
24. Morrey BF, Adams RA. Semi-constrained elbow replacement for distal humeral non-union. J Bone Joint Surg Br 1995;77:67-72.
25. Augereau B, Mansat P. Total elbow replacement implants. Rev Chir Orthop 2005;91:S31-96.
26. Kamineni S, Morrey BF. Distal humeral fractures treated with non-custom total elbow replacement. J Bone Joint Surg Am 2004;86:940-7.
27. Ray PS, Kakarlapudi K, Rajsekhar C, et al. Total elbow arthroplasty as primary treatment for distal humeral fractures in elderly patients.
Injury 2000;31:687-92.
28. Gambirasio R, Riand N, Stern R, et al. Total elbow replacement for complex fractures of the distal humerus: an option for the elderly patient. J Bone Joint Surg Am 2001;83:974-8.
29. Garcia JA, Mykula R, Stanley D. Complex fractures of the distal humerus in the elderly. J Bone Joint Surg Am 2002;84:812-6.
30. Lee KT, Lai CH, Singh S. Results of total elbow arthroplasty in the treatment of distal humerus fractures in elderly Asian patients. J Trauma 2006;61:889-92.
31. Prasad N, Dent C. Outcome of total elbow replacement for distal humeral fractures in the elderly: a comparison of primary surgery and surgery after failed internal fixation or conservative treatment. J Bone Joint Surg Br 2008;90:343-8.
32. McKee MD, Veillette CJH, 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.
33. Mansat P, Nouaille Degorce H, Bonnevialle N, Demezon H, Fabre T; SOFCOT. Total elbow arthroplasty for acute distal humeral fractures in patients over 65 years-old - results of a multicenterstudy in 87 patients. Orthop Traumatol Surg Res. 2013 Nov;99(7):779-84.
34. 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 treatmentalternative? A series of 20 cases. Orthop Traumatol Surg Res. 2013 Feb;99(1):10-20.
35. Lee BP, Adams RA, Morrey BF. Polyethylene wear after total elbow arthroplasty.J Bone Joint Surg Am. 2005 May;87(5):1080-7.
36. Parsons M, O’brien JR, Hughes JS. Elbow hemi-arthroplasty for acute and salvage reconstruction of intra-articular distal humerus fractures. Tech Shoulder Elbow Surg 2005;6(2): 87-97.
37. Adolfsson L, Hammer R. Elbow hemiathroplasty for acute reconstruction of intra-articular distal humeral fractures. A preliminary report involving 4 patients. Acta Orthop2006;77:785-7.
2. Robinson CM, Hill RM, Jacobs N, Dall G, Court-Brown C. Adult distal humeral metaphyseal fractures: epidemiology and results of treatment. J Orthop Trauma 2003;17:38-47.
3. Singer BR, McLauchlan GJ, Robinson CM, Christie J. Epidemiology of fractures in 15000 adults. J Bone Joint Surg Am 1998;80:243-8.
4. Rose SH, Melton LJ, Morrey BF, Ilstrup DM, Riggs BL. Epidemiologic features of humeral fractures. Clin Orthop1982;168:24-30.
5. Palvanen M, Kannus P, Niemi S, Parkkari J. Secular trends in distal humeral fractures of elderly women: nationwide statistics in Finland between 1970 and 2007. Bone. 2010 May;46(5):1355-8.
6. Diederichs G, Issever AS, Greiner S, Linke B, Korner J. Three-dimensional distribution of trabecular bone density and cortical thickness in the distal humerus. J Shoulder Elbow Surg 2009;18:399-407.
7. Morrey BF, Bryan RS, Dobyns JH, Linscheld RL. Total elbow arthroplasty. A five-year experience at the Mayo Clinic. J Bone Joint Surg Am 1981;63:1050-63.
8. Cobb TK, Morrey BF. Total elbow replacement arthroplasty primary treatment for distal humerus fractures in elderly patients. J Bone Joint Surg Am 1997;79:826-32
9. Hildebrand KA, Patterson SD, Regan WD, MacDermid JC, King GJ. Functional outcome of semiconstrained total elbow arthroplasty. J Bone Joint Surg Am 2000; 82:1379-86.
10. Gambirasio R, Riand N, Hoffmeyer P. Total elbow replacement for complex fractures of the distal humerus. An option for the elderly patient. J Bone Joint Surg Br 2001;83:974-8.
11. 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.
12. Frankle MA, Herscovici D, 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.
13. Prasad N, Dent C. Outcome of total elbow replacement for distal humeral fractures in the elderly. A comparison of primary surgery and surgery after failed internal fixation or conservative treatment. J Bone Joint Surg Br 2008;90:343-8.
14. Proust J, Oksman A, Charissoux JL, Mabit C, Arnaud JP. Results of internal fixation for intra-articular distal humerus fractures in elderly patients. Rev Chir Orthop 2007;93:798-806.
15. Gallucci GL, Gonzalez D, Boretto JG, Alfie VA, Donndorff A, De Carli P Artroplastia total del codo. Rev Asoc Argent Ortop Traumatol 2010;75(1):27-33.
16. Gallucci GL, Gonzalez D, Boretto JG, Alfie VA, Donndorff A, De Carli P Artroplastia total del codo posterior a una artritis séptica. Rev Asoc Argent Ortop Traumatol 2010;75(3):287-92.
17. Muller ME, Nazarian S. Comprehensive classification of fractures of long bones. Berlin: Springer Verlag; 1990.
18. Alonso-Llames M. Bilaterotricipital approach to the elbow. Its application in the osteosynthesis of supracondylar fractures of the humerus in children. Acta Orthop Scand 1972;43:479-90.
19. Morrey BF, An KN. Functional evaluation of the elbow. In: Morrey BF, editor. The elbow and its disorders. 2nd edition Philadelphia, PA: WB Saunders; 1993, 86-97.
20. Beaton DE, Katz JN, Fossel AH, Wright JG, Tarasuk V, Bombardier C. Measuring the whole or the parts? Validity,reliability, and responsiveness of the disabilities of the arm, shoulder and hand outcome measure in different regions of the upper extremity. J Hand Ther 2001;14:128-46.
21. Zagorski JB, Jennings JJ, Burkhalter WE, Uribe. Comminuted intraarticular fractures of the distal humeral condyles. Surgical vs. non-surgical treatment. Clin Orthop 1986;202: 197-204.
22. Helfet DL, Schmeling GJ. Bicondylarintraarticular fractures ofthe distal humerus in adults. Clin Orthop 1993;292:26-36.
23. Figgie MP, Inglis AE, Mow CS, Figgie 3rd HE. Salvage of nonunion of supracondylar fracture of the humerus by total elbow arthroplasty. J Bone Joint Surg Am 1989;71:1058—65
24. Morrey BF, Adams RA. Semi-constrained elbow replacement for distal humeral non-union. J Bone Joint Surg Br 1995;77:67-72.
25. Augereau B, Mansat P. Total elbow replacement implants. Rev Chir Orthop 2005;91:S31-96.
26. Kamineni S, Morrey BF. Distal humeral fractures treated with non-custom total elbow replacement. J Bone Joint Surg Am 2004;86:940-7.
27. Ray PS, Kakarlapudi K, Rajsekhar C, et al. Total elbow arthroplasty as primary treatment for distal humeral fractures in elderly patients.
Injury 2000;31:687-92.
28. Gambirasio R, Riand N, Stern R, et al. Total elbow replacement for complex fractures of the distal humerus: an option for the elderly patient. J Bone Joint Surg Am 2001;83:974-8.
29. Garcia JA, Mykula R, Stanley D. Complex fractures of the distal humerus in the elderly. J Bone Joint Surg Am 2002;84:812-6.
30. Lee KT, Lai CH, Singh S. Results of total elbow arthroplasty in the treatment of distal humerus fractures in elderly Asian patients. J Trauma 2006;61:889-92.
31. Prasad N, Dent C. Outcome of total elbow replacement for distal humeral fractures in the elderly: a comparison of primary surgery and surgery after failed internal fixation or conservative treatment. J Bone Joint Surg Br 2008;90:343-8.
32. McKee MD, Veillette CJH, 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.
33. Mansat P, Nouaille Degorce H, Bonnevialle N, Demezon H, Fabre T; SOFCOT. Total elbow arthroplasty for acute distal humeral fractures in patients over 65 years-old - results of a multicenterstudy in 87 patients. Orthop Traumatol Surg Res. 2013 Nov;99(7):779-84.
34. 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 treatmentalternative? A series of 20 cases. Orthop Traumatol Surg Res. 2013 Feb;99(1):10-20.
35. Lee BP, Adams RA, Morrey BF. Polyethylene wear after total elbow arthroplasty.J Bone Joint Surg Am. 2005 May;87(5):1080-7.
36. Parsons M, O’brien JR, Hughes JS. Elbow hemi-arthroplasty for acute and salvage reconstruction of intra-articular distal humerus fractures. Tech Shoulder Elbow Surg 2005;6(2): 87-97.
37. Adolfsson L, Hammer R. Elbow hemiathroplasty for acute reconstruction of intra-articular distal humeral fractures. A preliminary report involving 4 patients. Acta Orthop2006;77:785-7.