Total elbow replacement for complex fractures of the distal humerus

Gambirasio, R.; Riand, N.; Stern, R.; Hoffmeyer, P.

doi:10.1302/0301-620x.83b7.0830974

Cited by 66 publications

(25 citation statements)

References 26 publications

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“…ORIF carries the risks of nonunion, loss of fixation, infection, and stiffness. Though TEA carries the risks of loosening, infection, and periprosthetic fracture, it has the advantage that it allows immediate use of the limb and permits elbow function, unlike internal fixation 3444. Both procedures are technically challenging, and complications following these procedures are frequent.…”

Section: Discussionmentioning

confidence: 99%

“…These injuries are characterized by a transverse fracture at the level of olecranon and the coronoid fossae. The small size of the distal fragments has very little bone which is covered with articular fragments; this makes internal fixation difficult and hence primary elbow replacement is the treatment of choice 34…”

Section: Discussionmentioning

confidence: 99%

“…Good anatomical alignment, stabilization, and early mobilization can provide satisfactory results. Severe comminution, bone loss, and osteopenia predispose to unsatisfactory results because of inadequate fixation of the fracture 23. Over 25% of such fractures develop significant complications during treatment and a few of them may need further surgery 4.…”

Section: Introductionmentioning

confidence: 99%

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Controversies in the management of intra-articular fractures of distal humerus in adults

Babhulkar

2011

IJOO

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Background:The surgical approach, type of olecranon osteotomy, method of stabilization of osteotomy, type of fracture stabilization, orthogonal vs parallel plate fixation, need for transposition of ulnar nerve, place for primary total elbow replacement, and type of rehabilitation schedule after surgical fracture treatment are the controversial issues in the treatment of complex intra-articular distal humerus fractures (C2 and C3) in adults. Severe comminution, bone loss, and osteoporosis at the site of distal articular fractures of humerus often lead to unsatisfactory results due to inadequate fixation. We hereby report the outcome of a series of intracondylar fractures of the humerus treated by open reduction and internal fixation and discuss the controversies in light of published literature.Materials and Methods:One hundred and eighty-four patients of intra-articular fractures of distal humerus (C2 and C3) were operated by posterior transolecranon approach between January 1980 and December 2008. Initially, in the first part Chevron intra-articular osteotomy (n=108) was performed out of which 94 have been published in another publication. In later second part (1993 onward), extra-articular olecranon osteotomy (n=76) was routinely performed. Both columns were stably fixed by orthogonal methods; (n=174) however, during the last 2 years, in 10 patients with severe comminution with bone loss, stabilization was achieved by parallel plating. The osteotomy was routinely stabilized by tension band wiring with two parallel K-wires introduced up to the anterior ulnar cortex. The results were evaluated by the staging system of Caja et al. at a minimum follow-up of 2 years.Results:In the first part of the study (n=94), there was delayed union in 4% (n=4), with the fracture taking more than 20 weeks for union. There was delayed union of ulnar osteotomy (n=3) and failure of one tension band wiring, requiring revision. Some loss of motion was seen in 20% of cases and these patients did not achieve full flexion and extension. However, all these patients had useful range of function, with 20°–110° of flexion and full pronation-supination. As per the staging system of Caja et al., the results were in the range of excellent to good in 72% cases (n=67), fair in 19% (n=18), and poor in 9% patients (n=9). In the second part of study (n=90) dual plate fixation of both columns by orthogonal methods (n=80) and parallel plate fixation in 10 patients was performed. The results were excellent to good in 78 patients (86%).Conclusions:The high rate of union can be achieved in complex intra-articular fractures of distal humerus if the proper principles of stable fracture fixation are followed, i.e., a posterior transolecranon approach and dual fixation of both columns and restoration of the continuity of articular surface. The stability achieved by this technique permits institution of early intensive physiotherapy to restore elbow function.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Controversies in the management of intra-articular fractures of distal humerus in adults

Babhulkar

2011

IJOO

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“…Nevertheless, in the last few years, a reasonable evolution has occurred in terms of its indications and outcomes [5][6][7]. Nowadays, the use of elbow arthroplasty may be necessary in selected cases of complex fractures of the elbow, with good functional results [8,9].…”

Section: Introductionmentioning

confidence: 99%

Primary Total Elbow Arthroplasty in the Treatment of Complex Elbow Fracture: A Case Report

Miguel¹

2015

Trauma Cases Rev

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“…There are several reports on functional outcome and complications in distal humeral fractures treated with total elbow arthroplasty (Cobb and Morrey 1997, Gambirasio et al 2001, Kamineni and Morrey 2004. Fractures of the neck of femur and proximal humeral fractures can be treated with hemi-arthroplasty (i.e.…”

Section: Sammanfattning På Svenskamentioning

confidence: 99%

Arthroplasty in Elbow Fracture Treatment

Nestorson¹

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Total elbow replacement for complex fractures of the distal humerus

Cited by 66 publications

References 26 publications

Controversies in the management of intra-articular fractures of distal humerus in adults

Controversies in the management of intra-articular fractures of distal humerus in adults

Primary Total Elbow Arthroplasty in the Treatment of Complex Elbow Fracture: A Case Report

Arthroplasty in Elbow Fracture Treatment

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