Primary vs. secondary total elbow arthroplasty for distal humerus fractures

Ellwein, Alexander; Lill, Helmut; Smith, Tomas; Voigt, C.; Imrecke, Julia; Katthagen, J. Christoph

doi:10.1007/s11678-019-0523-3

Cited by 3 publications

(5 citation statements)

References 24 publications

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“…The DASH is a recommendable complementary questionnaire with well documented validity, excellent test-retest reliability and response to changes [15,28]. The results from this study do not achieve DASH scores observed by a recent work in 2019, that presented patients with a mean score of 24 ± 12 (range 8-43) and a mean age of 66 years [29]. Excellent scores were reported by a German Study in 2012, which presented a mean score of 8.43 (range 0-28) for patients with TEA (mean age = 65) [22].…”

Section: Discussioncontrasting

confidence: 78%

Total elbow arthroplasty in elderly trauma patients: adding a new perspective for functional evaluation

Mühlenfeld

Marzi

Frank

2022

Eur J Trauma Emerg Surg

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Purpose Total elbow arthroplasty (TEA) has evolved over the last years, with satisfactory early results, mainly not only in degenerative arthritis, but also increasingly after trauma. Outcome studies in recently published papers are mainly based on the range of motion (ROM), complication rate as well as patient-reported outcome scales and questionnaires. The purpose of this study was to add a new perspective with the “Purdue Pegboard” skill tests in a homogenous set of elderly trauma patients to contribute to a more precise objective outcome measurement in this specific population. Methods A retrospective review was performed on a consecutive cohort of all patients with age above 60 years that received TEA after trauma. Data from follow-up examinations over a standardized time-schedule within 2 years after TEA were included. Mayo Elbow Performance Score (MEPS), “Disability of Arm, Shoulder and Hand” (DASH) Questionnaire, ROM as well as test-scores using the Pegboard test were evaluated. Results Mean age was 76.0 years ± 10.3. Indications for TEA were posttraumatic arthrosis in 68.8% (n = 11) and extensive fractures that could not be reconstructed surgically in 31.3% (n = 5). The mean score of MEPS was 82.81 ± 16.63 and 29.18 ± 12.01 in the DASH. ROM presented with a mean of 109.7° ± 15.4. Patients demonstrated good, but marginally reduced test scores in the Pegboard skill tests in comparison with the healthy reference population. No relevant differences between the arm with and the arm without TEA (0.3 ± 3.6; p = 0.715) were noted after 2 years. Conclusion In the elderly trauma patient with complex fractures of the elbow, TEA is a good alternative to joint reconstruction using various osteosynthesis techniques. TEA is able to avoid revision surgery after open reduction and internal fixation of complex fractures. In cases of failed reconstruction, it is also a viable secondary procedure in posttraumatic arthrosis. Good outcomes in functionality and dexterity can be achieved. Skill tests like the Purdue Pegboard could add a valuable perspective in assessing functional outcomes after TEA.

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Section: Discussioncontrasting

confidence: 78%

Total elbow arthroplasty in elderly trauma patients: adding a new perspective for functional evaluation

Mühlenfeld

Marzi

Frank

2022

Eur J Trauma Emerg Surg

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“…These rates are similar to those published in the literature. 24 , 26 , 27 The high rate of infection (2 wound dehiscence, 2 prosthetic joint infection) in our study was likely because of patients with RA being on disease-modifying anti-rheumatic drugs, which was present in both cases of prosthetic joint infection and 1 of the cases of wound infection.…”

Section: Discussionmentioning

confidence: 71%

“…However, this was a small sample size and the difference was not statistically significant. 24 Ellwein et al 26 also published results from a small retrospective study of 23 patients (9 acute and 14 delayed TEA), showing significantly longer surgical time in the delayed cohort. Because of a small sample size, they, too, were not able to achieve statistical significance but the data suggested that delayed TEA may result in more pain and decreased function.…”

Section: Discussionmentioning

confidence: 98%

“…It has been challenging to compare outcomes after acute and delayed TEA for DHF due to the low numbers seen in the clinical setting. Published data have varied with some showing better outcomes in the acute TEA group, 26 while others showed no difference. 24 In general, survivorship data for TEA following DHF has been limited by high mortality rates.…”

Section: Discussionmentioning

confidence: 99%

“…While similar definitions have been reported in the literature, this cutoff for acute TEA versus nonsurgical treatment is somewhat arbitrary. 24 , 26 However, there was a minimum of 78 days between initial nonsurgical management and delayed TEA, and a minimum of 65 days between ORIF and delayed TEA, which helps to clearly distinguish the acute and delayed TEA groups. Lastly, the initial decision to pursue acute TEA versus ORIF versus nonsurgical management may have been influenced by the individual attending directing each patient’s care.…”

Section: Discussionmentioning

confidence: 99%

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