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Complex fractures of the distal humerus in the elderly: primary total elbow arthroplasty or open reduction and internal fixation? Mid-term follow-up

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Abstract

Objective

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.

Methods

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.

Results

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.

Conclusions

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.

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References

  1. Palvanen M, Kannus P, Niemi S, Parkkari J (2010) Secular trends in distal humeral fractures of elderly women: nationwide statistics in Finland between 1970 and 2007. Bone 46:1355–1358

    Article  Google Scholar 

  2. Gay DM, Lyman S, Do H et al (2012) Indications and reoperation rates for total elbow arthroplasty: an analysis of trends in New York State. J Bone Joint Surg Am 94:110–117

    Article  Google Scholar 

  3. Plaschke HC, Thillemann TM, Brorson S, Olsen BS (2014) Implant survival after total elbow arthroplasty: a retrospective study of 324 procedures performed from 1980 to 2008. J Shoulder Elb Surg 23:829–836. https://doi.org/10.1016/j.jse.2014.02.001

    Article  Google Scholar 

  4. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383. https://doi.org/10.1016/0021-9681(87)90171-8

    Article  CAS  Google Scholar 

  5. 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 

  6. Hastings H, Graham TJ (1994) The classification and treatment of heterotopic ossification about the elbow and forearm. Hand Clin 10:417–437

    Article  Google Scholar 

  7. Schindelar LE, Rondon AJ, Ilyas AM (2019) Total elbow arthroplasty versus open reduction and internal fixation for the management of distal humerus fractures in the elderly. Orthop 42:22–27. https://doi.org/10.3928/01477447-20181206-05

    Article  Google Scholar 

  8. McKee MD, Veillette CJH, Hall JA et al (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 18:3–12. https://doi.org/10.1016/j.jse.2008.06.005

    Article  Google Scholar 

  9. Dehghan N, Furey M, Schemitsch L et al (2019) Long-term outcomes of total elbow arthroplasty for distal humeral fracture: results from a prior randomized clinical trial. J Shoulder Elb Surg 28:2198–2204. https://doi.org/10.1016/j.jse.2019.06.004

    Article  Google Scholar 

  10. Jost B, Adams RA, Morrey BF (2008) Management of acute distal humeral fractures in patients with rheumatoid arthritis: a case series. J Bone Joint Surg (Am Vol) 90:2197–2205. https://doi.org/10.2106/JBJS.G.00024

    Article  Google Scholar 

  11. Egol KA, Tsai P, Vazques O, Tejwani NC (2011) Comparison of functional outcomes of total elbow arthroplasty vs plate fixation for distal humerus fractures in osteoporotic elbows. Am J Orthop (Belle Mead NJ) 40:67–71

    Google Scholar 

  12. Frankle MA, Herscovici D, DiPasquale TG et al (2003) 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 17:473–480. https://doi.org/10.1097/00005131-200308000-00001

    Article  PubMed  Google Scholar 

  13. Ellwein A, Lill H, Voigt C et al (2015) Arthroplasty compared to internal fixation by locking plate osteosynthesis in comminuted fractures of the distal humerus. Int Orthop (SICOT) 39:747–754. https://doi.org/10.1007/s00264-014-2635-0

    Article  Google Scholar 

  14. Lovy AJ, Keswani A, Koehler SM et al (2016) Short-term complications of distal humerus fractures in elderly patients: open reduction internal fixation versus total elbow arthroplasty. Geriatr Orthop Surg Rehabil 7:39–44. https://doi.org/10.1177/2151458516630030

    Article  PubMed  PubMed Central  Google Scholar 

  15. Medvedev G, Wang C, Amdur R et al (2017) Operative distal humerus fractures in older patients: predictors for early complications based on a national database. HSS Jrnl 13:212–216. https://doi.org/10.1007/s11420-017-9547-7

    Article  Google Scholar 

  16. Goyal N, Bohl DD, Ong KL et al (2020) Reoperation risk after total elbow arthroplasty versus open reduction internal fixation for distal humerus fractures in elderly patients. J Orthop Trauma 34:503–509. https://doi.org/10.1097/BOT.0000000000001767

    Article  PubMed  Google Scholar 

  17. Githens M, Yao J, Sox AHS, Bishop J (2014) Open reduction and internal fixation versus total elbow arthroplasty for the treatment of geriatric distal humerus fractures: a systematic review and meta-analysis. J Orthop Trauma 28:8

    Article  Google Scholar 

  18. Varecka TF, Myeroff C (2017) Distal humerus fractures in the elderly population. J Am Acad Orthop Surg 25:673–683. https://doi.org/10.5435/JAAOS-D-15-00683

    Article  PubMed  Google Scholar 

  19. Jordan RW, Saithna A, Kimani P et al (2018) Total elbow arthroplasty versus plate fixation for distal humeral fractures in elderly patients: a systematic review and meta-analysis. Curr Orthop Pract 29:16

    Google Scholar 

  20. Chalidis B, Dimitriou C, Papadopoulos P et al (2009) Total elbow arthroplasty for the treatment of insufficient distal humeral fractures. A retrospective clinical study and review of the literature. Injury 40:582–590. https://doi.org/10.1016/j.injury.2009.01.123

    Article  CAS  PubMed  Google Scholar 

  21. Baksi DP, Pal AK, Baksi D (2011) Prosthetic replacement of elbow for intercondylar fractures (recent or ununited) of humerus in the elderly. Int Orthop 35:1171–1177. https://doi.org/10.1007/s00264-010-1122-5

    Article  PubMed  Google Scholar 

  22. Ducrot G, Ehlinger M, Adam P et al (2013) Complex fractures of the distal humerus in the elderly: is primary total elbow arthroplasty a valid treatment alternative? A series of 20 cases. Orthop Traumatol Surg Res 99:10–20. https://doi.org/10.1016/j.otsr.2012.10.010

    Article  CAS  PubMed  Google Scholar 

  23. Mansat P, Nouaille Degorce H, Bonnevialle N et al (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. https://doi.org/10.1016/j.otsr.2013.08.003

    Article  CAS  PubMed  Google Scholar 

  24. Giannicola G, Scacchi M, Polimanti D, Cinotti G (2014) Discovery elbow system: 2- to 5-year results in distal humerus fractures and posttraumatic conditions: a prospective study on 24 patients. J Hand Surg [Am] 39:1746–1756. https://doi.org/10.1016/j.jhsa.2014.05.027

    Article  Google Scholar 

  25. 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. https://doi.org/10.1016/j.injury.2014.07.017

    Article  PubMed  PubMed Central  Google Scholar 

  26. Sørensen BW, Brorson S, Olsen BS (2014) Primary total elbow arthroplasty in complex fractures of the distal humerus. World J Orthop 5:368–372. https://doi.org/10.5312/wjo.v5.i3.368

    Article  PubMed  PubMed Central  Google Scholar 

  27. Barco R, Streubel PN, Morrey BF, Sanchez-Sotelo J (2017) Total elbow arthroplasty for distal humeral fractures: a ten-year-minimum follow-up study. J Bone Joint Surg Am 99:1524–1531. https://doi.org/10.2106/JBJS.16.01222

    Article  PubMed  Google Scholar 

  28. Lami D, Chivot M, Caubere A et al (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. https://doi.org/10.1016/j.otsr.2017.06.009

    Article  CAS  PubMed  Google Scholar 

  29. Antuña SA, Laakso RB, Barrera JL et al (2012) Linked total elbow arthroplasty as treatment of distal humerus fractures. Acta Orthop Belg 78:465–472

    PubMed  Google Scholar 

  30. Kholinne E, Altamimi LA, Aldayel A et al (2020) Primary linked total elbow arthroplasty for acute distal humerus fracture management: a systematic review of clinical outcome. Clin Orthop Surg 12:503. https://doi.org/10.4055/cios20012

    Article  PubMed  PubMed Central  Google Scholar 

  31. Kamineni S, Morrey BF (2004) Distal humeral fractures treated with noncustom total elbow replacement. J Bone Joint Surg Am 86(5):940–7. https://doi.org/10.2106/00004623-200405000-00009

    Article  CAS  PubMed  Google Scholar 

  32. Ali A, Shahane S, Stanley D (2010) Total elbow arthroplasty for distal humeral fractures: indications, surgical approach, technical tips, and outcome. J Shoulder Elb Surg 19:53–58. https://doi.org/10.1016/j.jse.2009.12.013

    Article  Google Scholar 

  33. Prasad N, Ali A, Stanley D (2016) Total elbow arthroplasty for non-rheumatoid patients with a fracture of the distal humerus: a minimum ten-year follow-up. Bone Joint J 98-B:381–386. https://doi.org/10.1302/0301-620X.98B3.35508

    Article  CAS  PubMed  Google Scholar 

  34. Pogliacomi F, Schiavi P, Defilippo M et al (2016) Total elbow arthroplasty following complex fractures of the distal humerus: results in patients over 65 years of age. Acta Biomed 87(2):148–155

    PubMed  Google Scholar 

  35. Korner J, Lill H, Müller LP et al (2005) Distal humerus fractures in elderly patients: results after open reduction and internal fixation. Osteoporos Int 16:S73–S79. https://doi.org/10.1007/s00198-004-1764-5

    Article  PubMed  Google Scholar 

  36. Huang T-L, Chiu F-Y, Chuang T-Y, Chen T-H (2005) The results of open reduction and internal fixation in elderly patients with severe fractures of the distal humerus: a critical analysis of the results. J Trauma Injury Infect Crit Care 58:62–69. https://doi.org/10.1097/01.TA.0000154058.20429.9C

    Article  Google Scholar 

  37. Huang JI, Paczas M, Hoyen HA, Vallier HA (2011) Functional outcome after open reduction internal fixation of intra-articular fractures of the distal humerus in the elderly. J Orthop Trauma 25:259–265. https://doi.org/10.1097/BOT.0b013e3181dfd348

    Article  PubMed  Google Scholar 

  38. Serrano-Mateo L, Lopiz Y, León-Serrano C, García-Fernández C, López-Durán-Stern L, Marco F (2014) Resultados de la reducción abierta y osteosíntesis de fracturas de húmero distal en mayores de 65 años [Results after internal fixation of humerus distal fractures in patients over than 65 years old]. Rev Esp Cir Ortop Traumatol 58(1):31–37. https://doi.org/10.1016/j.recot.2013.09.008

    Article  CAS  PubMed  Google Scholar 

  39. Biz C, Sperotto SP, Maschio N et al (2017) The challenging surgical treatment of closed distal humerus fractures in elderly and octogenarian patients: radiographic and functional outcomes with a minimum follow-up of 24 months. Arch Orthop Trauma Surg 137:1371–1383. https://doi.org/10.1007/s00402-017-2762-3

    Article  PubMed  Google Scholar 

  40. Foreman KJ, Marquez N, Dolgert A et al (2018) Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016-40 for 195 countries and territories. Lancet 392:2052–2090. https://doi.org/10.1016/S0140-6736(18)31694-5

    Article  PubMed  PubMed Central  Google Scholar 

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Author notes

  1. Yaiza Lopiz and Daniel Garríguez-Pérez contributed equally to this work.

Authors and Affiliations

  1. Shoulder and Elbow Unit, Department of Traumatology and Orthopaedic Surgery, Clínico San Carlos Hospital, 5 Planta, Ala Sur. Calle Profesor Martín Lagos s/n, 28004, Madrid, España

    Yaiza Lopiz, Daniel Garríguez-Pérez, Carlos García-Fernández, Laura del Baño, María Galán-Olleros & Fernando Marco

  2. Department of Surgery, Complutense University, Madrid, Spain

    Yaiza Lopiz & Fernando Marco

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  1. Yaiza Lopiz
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Correspondence to Yaiza Lopiz.

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The authors declare no competing interests.

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Institutional Review Board (IRB) “Ethics Committee for Clinical Research” (CEIC) from Clínico San Carlos Hospital (Madrid,Spain) approve the present study (19/418-E_TFG).

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Informed consent was obtained from all individual participants included in the study.

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Level of evidence: Level III, Comparative clinical study; Treatment study

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Lopiz, Y., Garríguez-Pérez, D., García-Fernández, C. et al. Complex fractures of the distal humerus in the elderly: primary total elbow arthroplasty or open reduction and internal fixation? Mid-term follow-up. International Orthopaedics (SICOT) 45, 2103–2110 (2021). https://doi.org/10.1007/s00264-021-05027-z

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