Operative Distal Humerus Fractures in Older Patients: Predictors for Early Complications Based on a National Database

Abstract

Background

Open reduction internal fixation (ORIF) and total elbow arthroplasty (TEA) have both been utilized in the treatment of distal humerus fractures in patients over 65 years of age. Comparisons of early complications between these procedures have not been well described.

Questions/Purposes

The purpose of this study is to evaluate complication rates in the treatment of distal humerus fractures in elderly patients and to utilize prediction models to identify risk factors associated with postoperative complications. Additionally, to compare ORIF and TEA treatment.

Methods

A retrospective case series was performed by querying the National Surgical Quality Improvement Program for both ORIF and TEA performed for distal humerus fractures in patients over the age of 65 years between 2005 and 2014. We examined both preoperative risk factors and complications within 30 days in these three groups.

Results

The sample included 216 ORIF and 65 TEA cases. No outcomes examined differed significantly between treatment groups. The most common outcome for both groups was bleeding requiring transfusion (8%). The observed effect size for the association between procedure and the composite morbidity outcome indicated little to no association (phi = 0.004). Furthermore, no presurgery variables were found to be significantly associated with procedure type. The only predictor with a significant independent association with the composite outcome, regardless of procedure type, was ASA class 3/4.

Conclusion

Clinical complications were low no matter the type of treatment. Low preoperative hematocrit was a risk factor in both ORIF and TEA.

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Correspondence to Gleb Medvedev MD.

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Conflict of Interest

Gleb Medvedev, MD, Charles Wang, BS, and Richard Amdur, PhD, have declared that they have no conflicts of interest. Robert Neviaser, MD, reports personal fees from Saunders/Mosby-Elsevier, outside the work. Andrew Neviaser, MD reports personal fees from Depuy Mitek and Synthes, outside the work.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).

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Level of Evidence: Level IV: Prognostic Study

Work performed at George Washington University.

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Medvedev, G., Wang, C., Amdur, R. et al. Operative Distal Humerus Fractures in Older Patients: Predictors for Early Complications Based on a National Database. HSS Jrnl 13, 212–216 (2017). https://doi.org/10.1007/s11420-017-9547-7

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Keywords

  • distal humerus fracture
  • total elbow arthroplasty
  • elderly
  • older patient
  • NSQIP