Outcomes of distal humerus fractures in patients above 65 years of age treated by plate fixation

Clavert, Philippe; Ducrot, G.; Sirveaux, François; Fabre, Thierry; Mansat, Pierre

doi:10.1016/j.otsr.2013.08.001

Cited by 43 publications

(33 citation statements)

References 25 publications

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“…The surgical revision rate in elbow surgery is quite high compared to other anatomical regions [ 15 – 18 ], which is supported by the findings in this study. In 8 of 36 patients (22.2 %) the index operation was performed due to implant failure or secondary dislocation of a previous surgery.…”

Section: Discussionsupporting

confidence: 90%

“…Intra-articular fractures of the elbow are prone to revision surgery in the case of secondary dislocation, intra-articular position of screws or remaining gaps after primary surgical treatment. In the treatment of elbow fractures a satisfactory outcome relies on anatomical reconstruction of the joint surface and proper implant placement [ 15 – 19 ]. Based on this background, intraoperative 3D imaging may be beneficial in the treatment of elbow fractures to improve outcome and prevent revision surgeries.…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative 3D imaging in the treatment of elbow fractures - a retrospective analysis of indications, intraoperative revision rates, and implications in 36 cases

et al. 2016

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BackgroundThree-dimensional (3D) imaging with a mobile C-arm has proven to be a valuable intraoperative tool in trauma surgery. However, little data is available concerning its use in the treatment of elbow fractures. The aim of the current study was to determine the intraoperative findings and consequences of 3D imaging in the treatment of elbow fractures.MethodsBetween 2001 and 2015, prospectively collected data of 36 patients who underwent intraoperative 3D imaging during elbow surgery were recorded. The findings and consequences of the intraoperative 3D scans were analyzed in a retrospective chart review. For clinical evaluation the analysis included the patients’ medical history, the injury pattern of the affected elbow and concomitant injuries. Intraoperative and postoperative complications and revision surgeries were evaluated as well.ResultsIn 6 patients (16.7 %) analysis of the intraoperative 3D scan led to an immediate revision due to the detection of intra-articular screw placement (n = 3, 8.3 %) and remaining intra-articular step of >2 mm (n = 3, 8.3 %). In all of these patients, correct implant positioning and anatomical reduction could be achieved after immediate intraoperative revision, which was verified by a repeated intraoperative 3D scan. None of the 36 patients needed surgical revision based on postoperative radiological examinations due to secondary dislocation, wrong implant placement or remaining steps in the articular surface.ConclusionsIntraoperative 3D imaging offers additional information about fracture reduction and implant positioning in the treatment of elbow fractures compared to conventional intraoperative 2D imaging. It may therefore reduce the need for revision surgery. The value of intraoperative 3D imaging for clinical outcomes still needs to be assessed.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Intraoperative 3D imaging in the treatment of elbow fractures - a retrospective analysis of indications, intraoperative revision rates, and implications in 36 cases

et al. 2016

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“…Otherwise an operative treatment is recommended. The development of locking compressions plates improved the primary stability of fracture fixation [3] especially in patients with poor bone mineral quality [4][5][6]. Open reduction and internal fixation (ORIF) with a double locking plate osteosynthesis became the gold standard for the fixation of intra-articular distal humerus fractures, while the positioning and configuration of the plates is still discussed [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Arthroplasty compared to internal fixation by locking plate osteosynthesis in comminuted fractures of the distal humerus

Ellwein

Lill

Voigt

et al. 2014

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to evaluate and compare the results after double locking plate osteosynthesis (ORIF) and total elbow arthroplasty (TEA) in AO type C fractures of the distal humerus. Methods This retrospective study includes clinical results of 29 patients (9xTEA, 20xORIF) with a mean age of 62 years. The male to female ratio was 8:21. Range of motion, MEPS, DASH and complications were evaluated. Patients older than 60 years (n=19) were filtered and compared statistically.Results After a mean follow-up of 25 months the ORIF-group reached an extension-flexion of 99°±23°and the TEA-group of 111°±13°. The ORIF-group vs. the TEA-group had a mean MEPS of 85±17 vs. 94±11 and DASH of 34±24 vs. 24±12. In patients older than 60 years extension-flexion was 97°±23°a fter ORIF and 110°±14 after TEA (p=0.237). The ORIFgroup vs. the TEA-group had a mean MEPS of 82±21 vs. 94 ±11 (p=0.078) and DASH of 45±18 vs. 26±11 (p=0.023). The ORIF-group had a 4.4 times higher risk for major complications.Conclusion TEA and ORIF lead to comparable functional results, but major complications are more common after ORIF. Despite this, ORIF remains the gold standard for younger and older patients because of the lifelong loading limitation after TEA, unknown implant survival and problematic revision surgery. For patients older than 60 years a primary TEA can be recommended in exceptional cases, if the loading limitation is acceptable for the individual or the fracture is not reconstructable.

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“…Multiple studies have compared the functional outcome of TEA versus ORIF and found both to be favorable. 8 , 9 , 11 , 13 , 17 – 22 …”

Section: Discussionmentioning

confidence: 99%

Short-Term Complications of Distal Humerus Fractures in Elderly Patients

Lovy

Keswani

Koehler

et al. 2016

Geriatr Orthop Surg Rehabil

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Background:The purpose of this study was to evaluate 30-day postoperative complications of open reduction and internal fixation [ORIF] and total elbow arthroplasty [TEA] for the treatment of distal humerus fractures in elderly patients using a validated national database.Methods:Review of the National Surgical Quality Improvement Program (NSQIP) Database identified all elderly patients (>65 years) who underwent TEA or ORIF for the treatment of closed intra-articular distal humerus fractures from 2007 to 2013. Bivariate and multivariate analyses of risk factors for 30-day adverse events as defined by NSQIP between ORIF and TEA groups were assessed using preoperative and intraoperative variables.Results:Among the 176 patients with distal humerus fractures, there were 33 TEA and 143 ORIF. There was no difference in age, medical comorbidities, or functional status. Total elbow arthroplasty was associated with an increased odds of severe adverse event compared to ORIF (odds ratio = 1.57, P = .16), although it did not achieve statistical significance. Infection rate was 0.7% in ORIF and 0.0% in TEA (P = .99). Insulin-dependent diabetes and functional status were significant independent predictors of postoperative adverse events. Operative time (165 minutes vs 140 minutes, P = .06) and postoperative length of stay (3.6 days vs 2.3 days, P = 0.03) were longer for TEA compared to ORIF.Conclusion:Open reduction and internal fixation and TEA have similar 30-day postoperative complications for the treatment of distal humerus fractures among elderly patients. Despite favorable trends for TEA in recent studies, additional clinical results are needed to understand complications and limitation of TEA.Level of evidence:Level III, prognostic study.

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Outcomes of distal humerus fractures in patients above 65 years of age treated by plate fixation

Abstract: IV.

Cited by 43 publications

References 25 publications

Intraoperative 3D imaging in the treatment of elbow fractures - a retrospective analysis of indications, intraoperative revision rates, and implications in 36 cases

Intraoperative 3D imaging in the treatment of elbow fractures - a retrospective analysis of indications, intraoperative revision rates, and implications in 36 cases

Arthroplasty compared to internal fixation by locking plate osteosynthesis in comminuted fractures of the distal humerus

Short-Term Complications of Distal Humerus Fractures in Elderly Patients

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