Short-Term Complications of Distal Humerus Fractures in Elderly Patients

Abstract

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.

Current concepts in elbow arthroplasty

“…Lovy et al recently reported a multivariate analysis of risk factors for complications following TEAs using a national database. 18 Their study showed significantly lower risk of infection for the non-smoking patient as well as those undergoing shorter operation time. 18 Patients should counselled on smoking cessation prior to performing elective TEA.…”

“… 18 Their study showed significantly lower risk of infection for the non-smoking patient as well as those undergoing shorter operation time. 18 Patients should counselled on smoking cessation prior to performing elective TEA. Although operation time is confounded by many variables including case difficulty, those surgeons performing relatively few (< 5 annually) TEAs have been reported to have worse outcomes, and all surgeons are encouraged to review techniques and instrumentation prior to performing the operation.…”

Nonoperative treatment of distal humerus fractures in the elderly yields satisfactory functional outcomes and low conversion to delayed surgery: a systematic review

“… 20 Prosthetic replacement with total elbow arthroplasty (TEA) has shown promise in these patients, 21 , 26 , 29 , 31 as well as those with rheumatoid arthritis, failed fixation, and nonunion. 8 , 23 , 32 Consequently, nonoperative treatment has been reserved for low demand, medically unwell patients with advanced comorbidities that preclude surgery. 20 , 31 …”