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BACKGROUND: The most common surgical procedure for the treatment of distal humeral fracture in the elderly is open reduction and internal fixation and total elbow arthroplasty. There is still a lack of systematic evaluation of the efficacy between the two methods, and further research is needed to better guide clinical work. OBJECTIVE: To compare the clinical efficacy of open reduction and internal fixation combined with total elbow arthroplasty in the treatment of elderly patients with distal humeral fractures. METHODS: The computer was used to retrieve information in databases such as PubMed, The Cochrane Library, EMBASE, Science Direct, CNKI, Wanfang, and VIP. An observational cohort study or randomized controlled trial was performed in the study of open reduction and internal fixation/total elbow arthroplasty for the treatment of elderly patients with distal humeral fractures. The search period was 1998-2018. Studies were read and screened; data were extracted and the quality of the study was assessed by two persons independently. Data analysis was performed using RevMan 5.3. RESULTS AND CONCLUSION: (1) A total of 10 studies were included in 1 069 patients. (2) Meta-analysis results showed that total elbow arthroplasty group was superior to the open reduction and internal fixation group in the incidence of total complications (OR=1.67, 95%C/: 1.19-2.35, P=0.003), Mayo elbow performance score at the last follow-up (MD=-12.68, 95%C/: -16.60 to -8.77, P 0.05). (4) These results confirmed that the total complication rate of the total elbow arthroplasty group was lower than that of the open reduction and internal fixation group, and the elbow joint function was better than that of the open reduction and internal fixation group. For elderly patients with distal humeral fracture, the degree of osteoporosis is different, and the articular surface is difficult to be effectively reset. The treatment of total elbow arthroplasty should be considered.
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PURPOSE: Twenty early surgical management cases of distal humerus type-C fractures were analyzed. MATERIALS AND METHODS: This study analyzed 20 early patients, who received surgical management of distal humerus type-C fractures, and could be followed-ups for more than one year between March of 2013 and May of 2015. The operative time, bone union time, and elbow range of motion were analyzed. The Mayo's functional score was used to evaluate their postoperative function. The primary and secondary complications of each patient immediately after each of their surgery were also reviewed. RESULTS: All patient groups achieved bone union within an average period of 16.4 weeks. Based on the Mayo functional score, 6, 10, and 4 patients scored excellent, good, and fair, respectively. The average range of motion was a flexion contracture of 14.5° with a follow-up improvement averaging 120.7°. Six patients received nine revision operations due to major and minor complications. Two patients received revision fixation from an inadequate fixating power, and another patient received an ulnar nerve transposition. Other complications included olecranon osteotomy site displacement, superficial operational site infection, and pin loosening. CONCLUSION: Distal humerus fractures of the AO-C type can cause a range of complications and has a very high rate of revision due to its difficult nature of surgical manageability. Therefore, it is imperative for a surgeon to expect various complications beforehand and a careful approach to their postoperative rehabilitation is essential.
Subject(s)
Humans , Contracture , Elbow , Follow-Up Studies , Humerus , Intra-Articular Fractures , Olecranon Process , Operative Time , Orthopedics , Osteotomy , Range of Motion, Articular , Rehabilitation , Surgeons , Ulnar NerveABSTRACT
Objective: To investigate the effect of functional exercises at different time and different immobilization positions on the functional recovery of elbow joint with type C distal humeral fractures.
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Objetivo: Comunicar los resultados clínico-radiológicos del tratamiento de las fracturas de húmero distal con prótesis total de codo en pacientes >65 años. Materiales y Métodos: Estudio retrospectivo en dos centros quirúrgicos. Criterios de inclusión: pacientes con fractura de húmero distal, >65 años, operados con prótesis total de Coonrad-Morrey y seguimiento >1 año. Se incluyeron 21 pacientes (20 mujeres), edad promedio: 79 años. Según la clasificación AO, 13 C3, siete C2 y una A2. Todos fueron operados sin desinserción del aparato extensor. Seguimiento promedio: 40 meses. Resultados: La flexo-extensión fue de 123-17°, arco de movilidad de 106° (80% con respecto al lado sano). Dolor según la escala analógica visual: 1 punto. El puntaje de la Clínica Mayo promedio fue 83: resultado excelente (8 pacientes), bueno (11 pacientes), regular (1 caso) y malo (1 caso). El puntaje DASH promedio fue de 24. No hubo aflojamientos en 13 pacientes. Se produjeron nueve complicaciones: dos pacientes fueron operados nuevamente por desgaste del polietileno, uno operado otra vez al mes de la cirugía para la recolocación del perno de ensamble, dos parestesias del nervio cubital, una falsa vía intraoperatoria, un hematoma de la herida que necesitó de un colgajo braquial y dos aflojamientos protésicos. Conclusiones: El tratamiento de las fracturas de húmero distal con prótesis total de codo en pacientes >65 años puede ofrecer una opción terapéutica razonable, pero las indicaciones deben limitarse a fracturas complejas donde la fijación interna puede ser precaria, en pacientes con osteoporosis y con baja demanda funcional.
Objective: To report the clinical-functional results of humeral distal fracture treatment with total elbow prosthesis in patients older than 65 years. Methods: Retrospective study performed in two surgical centers. Inclusion criteria: patients with humeral distal fractures, >65 years, operated on with Coonrad-Morrey prostheses, and with a follow-up >1 year. Twenty-one patients were included (20 women) with an average age of 79 years. According to AO classification: 13 type C3 fractures, 7 C2 and 1 A2. All patients were operated on without disinsertion of the extensor mechanism. Average follow-up: 40 months. Results: Flexion-extension: 123-17°, with a total arc of mobility of 106° (80% of the contralateral side). Pain according to visual analogue scale was 1. The Mayo Clinic score was 83 points, results were excellent (8 patients), good (11 patients), regular (one case) and bad (one case). Average DASH score was 24 points. No loosening of the implants was evidenced in 13 patients. Nine complications were reported: 2 reoperations for polyethylene wear, one early decoupling of the prosthesis, 2 ulnar nerve paresthesia, one patient presented a false intraoperative via, one hematoma that needed a local flap and 2 loosening of the prosthesis. Conclusions: Treatment of humeral distal fractures with total elbow arthroplasty in patients older than 65 years may be a good therapeutic option, but indications must be limited to patients with complex fractures, bad bone quality, with osteoporosis and low functional demands.
Subject(s)
Middle Aged , Aged, 80 and over , Elbow Joint/surgery , Arthroplasty, Replacement, Elbow/methods , Humeral Fractures/surgeryABSTRACT
Objective:To evaluate the clinical effect of open reduction and internal fixation for the intercondylar distal humeral fracture with double-plate fixation.Method:A total of 26 cases with intercondylar distal humeral fracture were treated with the double-plate fixation via olecroanon approach.According to the AO/ASIF classification,there were 3 cases with C1,19 cases with C2 and 4 cases with C3.Cassebaum numerical rating system was employed to evaluated postoperative function of the involved elbow.Results:The post-operative function in 26 cases was evaluated according to the Cassebaum numerical rating system,follow-up averaged 15 months,and the results were:excellent in 19 cases(65.4%);good in 9 cases(23.1%);fair in 2 cases(7.7%);poor in 1 case(3.8%).The excellent rate was 88.5%.Conclusion:Double-plate fixation is characterized by stable fixation,minor complication and high satisfaction,and hence is an effective method for intercondylar distal humeral fracture.