Meta-analysis of open reduction and internal fixation versus total elbow arthroplasty for distal humeral fracture in the elderly / 中国组织工程研究

ABSTRACT

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.