Skip to main content

Advertisement

SpringerLink
Log in

Digastric olecranon osteotomy a new approach to the elbow: retrospective study of 24 Coonrad–Morrey® total elbow arthroplasty at 30-month follow-up

  • Original Article • ELBOW - TRAUMA
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

Digastric olecranon osteotomy approach allows an excellent articular exposure and preserves principal vascular supply and the continuity of the extensor apparatus. The aim of this study was to assess the early clinical and radiological outcome after total elbow arthroplasty implanted from a digastric olecranon osteotomy approach.

Methods

We retrospectively enrolled 22 patients (two men and twenty women) treated with 24 Coonrad–Morrey® total elbow arthroplasty implanted from a digastric olecranon osteotomy approach in Island of France (Paris, Argenteuil and Saint-Denis). The mean age was 80 years (50–96). We treated 20 fractures; according to AO classification, seven patients suffered from a C1 fracture, seven from a C3 and C2, two from malunions, and four from rheumatoid arthritis. The mean time of follow-up was 30 months (6–132). Clinical outcomes were assessed with the Mayo elbow performance score. We evaluated triceps strength and radiographic healing.

Results

At the latest follow-up, the average flexion arc was 23° (5°–50°) to 112° (95°–130°). The Mayo elbow performance score averaged 92 points (75–100). The mean strength of the triceps in extension and flexion was, respectively, 1.9 and 4.7 kgs. All elbows were stable. A single immediate post-operative wound infection was reported and did not require any surgical revision. Radiological consolidation of the olecranon osteotomy was assessed in sixteen patients between 8 and 16 weeks. Heterotopic ossifications were noted in one elbow. One patient had an elbow dislocation by fracture of the axe’s component.

Conclusion

The early clinical and radiological outcomes are promising and support the use of digastric olecranon osteotomy for the implantation of total elbow arthroplasty.

Level of evidence

Treatment study, level IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Cobb TK, Morrey BF (1997) Total elbow arthroplasty as primary treatment for distal humeral fractures in elderly patients -. J Bone Joint Surg Am 79:826–832

    Article  CAS  Google Scholar 

  2. Gambirasio R, Riand N, Stern R, Hoffmeyer P (2001) Total elbow replacement for complex fractures of the distal humerus. An option for the elderly patient. J Bone Joint Surg Br 83:974–978

    Article  CAS  Google Scholar 

  3. Garcia JA, Mykula R, Stanley D (2002) Complex fractures of the distal humerus in the elderly. The role of total elbow replacement as primary treatment. J Bone Joint Surg Br 84:812–816

    Article  CAS  Google Scholar 

  4. Kamineni S, Morrey BF (2004) Distal humeral fractures treated with noncustom total elbow replacement. J Bone Joint Surg Am 86(A):940–947

    Article  CAS  Google Scholar 

  5. Prasad N, Dent C (2008) 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 90:343–348

    Article  CAS  Google Scholar 

  6. Ray PS, Kakarlapudi K, Rajsekhar C, Bhamra MS (2000) Total elbow arthroplasty as primary treatment for distal humeral fractures in elderly patients. Injury 31:687–692

    Article  CAS  Google Scholar 

  7. McKee MD, Veillette CJH, Hall JA (2009) 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 Elb Surg Am 18:3–12

    Article  Google Scholar 

  8. Linn MS, Gardner MJ, McAndrew CM et al (2014) Is primary total elbow arthroplasty safe for the treatment of open intra-articular distal humerus fractures? Injury 45:1747–1751

    Article  Google Scholar 

  9. Cottias P, Camara KB, Clavert P et al (2010) Digastric olecranon osteotomy : feasibility study of a new approach to the elbow. Surg Radiol Anat 32:485–489

    Article  Google Scholar 

  10. Larsen A, Dale K, Eek M (1977) Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference films. Acta Radiol Diagn (Stockh) 18:481–491

    Article  CAS  Google Scholar 

  11. Müller M (1990) Comprehensive classification of fractures of long bones. Springer, Berlin

    Book  Google Scholar 

  12. Chao EY, An KN, Askew LJ, Morrey BF (1980) Electrogoniometer for the measurement of human elbow joint rotation. J Biomech Eng 102:301–310

    Article  CAS  Google Scholar 

  13. Morrey BF, Bryan RS, Dobyns JH, Linscheid RL (1981) Total elbow arthroplasty. A five-year experience at the Mayo Clinic. J Bone Joint Surg Am 63:1050–1063

    Article  CAS  Google Scholar 

  14. Lami D, Chivot M, Caubere A, Galland A, Argenson JN (2017) First-line management of distal humerus fracture by total elbow arthroplasty in geriatric traumatology: results in a 21-patient series at a minimum 2 years’ follow-up. Orthop Traumatol Surg Res 103:891–897

    Article  CAS  Google Scholar 

  15. Mansat P, Bonnevialle N, Rongières M et al (2014) The role of total elbow arthroplasty in traumatology. Orthop Traumatol Surg Res 100:S293–S298

    Article  CAS  Google Scholar 

  16. Kodama A, Mizuseki T, Adachi N (2017) Kudo type-5 total elbow arthroplasty for patients with rheumatoid arthritis: a minimum ten-year follow-up study. J Bone Joint Surg Am 99(B):818–823

    Article  Google Scholar 

  17. Mansat P, Nouaille Degorce H, Bonnevialle N, Demezon H, Fabre T (2013) 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 99:779–784

    Article  CAS  Google Scholar 

  18. Welsink CL, Lambers KTA, van Deurzen DFP, Eygendaal D, van den Bekerom MPJ (2017) Total elbow arthroplasty: a systematic review. J Bone Joint Surg Rev 5:e4

    Google Scholar 

  19. Sharma S, John R, Dhillon MS, Kishore K (2018) Surgical approaches for open reduction and internal fixation of intra-articular distal humerus fractures in adults: a systematic review and meta-analysis-. Injury 49:1381–1391

    Article  Google Scholar 

  20. Booker SJ, Smith CD (2017) Triceps on approach for total elbow arthroplasty: worth preserving? A review of approaches for total elbow arthroplasty. Shoulder Elb 9:105–111

    Article  Google Scholar 

  21. Celli A, Arash A, Adams RA, Morrey BF (2005) Triceps insufficiency following total elbow arthroplasty. J Bone Joint Surg Am 87:1957–1964

    Article  Google Scholar 

  22. Guerroudj M, de Longueville J-C, Rooze M et al (2007) Biomechanical properties of triceps brachii tendon after in vitro simulation of different posterior surgical approaches. J Shoulder Elb Surg Am 16:849–853

    Article  Google Scholar 

  23. Wilkinson JM, Stanley D (2001) Posterior surgical approaches to the elbow: a comparative anatomic study. J Shoulder Elb Surg Am 10:380–382

    Article  CAS  Google Scholar 

  24. Cheung EV, Steinmann SP (2009) Surgical approaches to the elbow. J Am Acad Orthop Surg 17:325–333

    Article  Google Scholar 

  25. McKee M (2003) Posterior surgical approaches to the elbow: a comparative anatomic study. J Shoulder Elb Surg Am 12:204–208

    Article  Google Scholar 

  26. Iselin LD, Mett T, Babst R et al (2014) The triceps reflecting approach (Bryan-Morrey) for distal humerus fracture osteosynthesis. BMC Musculoskelet Disord 15:1–5

    Article  Google Scholar 

  27. Bryan RS, Morrey BF (1982) Extensive posterior exposure of the elbow. A triceps-sparing approach. Clin Orthop Relat Res 166:188–1992

    Google Scholar 

  28. Chen G, Liao Q, Luo W et al (2011) Triceps-sparing versus olecranon osteotomy for ORIF: analysis of 67 cases of intercondylar fractures of the distal humerus. Injury 42:366–370

    Article  Google Scholar 

  29. Hohman DW, Nodzo SR, Qvick LM, Duquin TR, Paterson PP (2014) Hemiarthroplasty of the distal humerus for acute and chronic complex intra-articular injuries. J Shoulder Elbow Surg 23:265–272

    Article  Google Scholar 

  30. Smith GC, Hughes JS (2013) Unreconstructable acute distal humeral fractures and their sequelae treated with distal humeral hemiarthroplasty: a two-year to eleven-year follow-up. J Shoulder Elbow Surg 22:1710–1723

    Article  Google Scholar 

  31. Marra G, Morrey BF, Gallay SH et al (2006) Fracture and nonunion of the olecranon in total elbow arthroplasty. J Shoulder Elb Surg Am 15:486–494

    Article  Google Scholar 

  32. Yamaguchi K, Sweet FA, Bindra R et al (1997) The extraosseous and intraosseous arterial anatomy of the adult elbow. J Bone Joint Surg Am 79:1653–1662

    Article  CAS  Google Scholar 

  33. Pooley J, Salvador Carreno J (2015) Total elbow joint replacement for fractures in the elderly—functional and radiological outcomes. Injury 46(5):37–42

    Article  Google Scholar 

Download references

Funding

There is no funding source.

Author information

Authors and Affiliations

  1. Orthopaedic Surgery Departement, Hôpital Cochin, Paris, France

    Pascal Cottias, Philippe Leclerc, Amine Zaoui & Philippe Anract

  2. Orthopaedic Surgery Departement, Hôpital Saverne France, Saverne, France

    Raphiq Khallouk

  3. Orthopaedic Surgery Departement, Hôpital Argenteuil France, Argenteuil, France

    Abdel Massih Abouchaaya

Authors
  1. Pascal Cottias
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Philippe Leclerc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amine Zaoui
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Abdel Massih Abouchaaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Raphiq Khallouk
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Philippe Anract
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pascal Cottias.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the ethical committee of the hospital.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cottias, P., Leclerc, P., Zaoui, A. et al. Digastric olecranon osteotomy a new approach to the elbow: retrospective study of 24 Coonrad–Morrey® total elbow arthroplasty at 30-month follow-up. Eur J Orthop Surg Traumatol 30, 485–491 (2020). https://doi.org/10.1007/s00590-019-02590-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-019-02590-5

Keywords

Search

Navigation