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Surgeons use total elbow arthroplasty to treat intercondylar fractures in elderly
Baksi DP. Int Orthop. 2010. doi:10.1007/s00264-010-1122-5.
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Prosthetic elbow replacement for intercondylar fractures yielded excellent results in the majority of elderly patients in this trial.
From January 2003 to April 2009, 41 patients with intercondylar humeral fractures (21 fresh and 20 nonunions) underwent total elbow arthroplasty with Baksi’s recent version of the sloppy hinge, according to Durga P. Baksi, MD, department of orthopedics, Medical College and Hospital, Kolkata, India, and colleagues. Twelve patients were AO classification type C2 and nine were type C3 closed fractures of 7 days mean duration according to the Muller classification.
Of 20 nonunions, nine were untreated nonunions of a mean duration of 11 months; 11 occurred after failed internal fixation. Follow-up ranged from 12 to 88 months (mean, 55.5 months).
The surgeons obtained a mean arc of postoperative elbow flexion of 25º to 130º in 33 patients (80.5%). In the fresh fracture group, 19 patients (90.5%) had excellent results, one patient had good results and another patient failed, according to the Mayo elbow performance score. In the nonunion group, 17 patients (85%) had excellent results, two had had good results and one patient failed. Both failures were caused by a deep infection that required prosthesis removal. There were other complications: transient ulnar neurapraxia in three patients;, prosthesis disassembly in one; patchy heterotopic ossification in two; and one patient had localized radiolucency around the humeral stem flanges.
This research has several strengths. First, it offers international experience. Second, it re-enforces from another perspective what is already accepted as the treatment for both acute and chronic conditions. There is a reasonable sample size. The researchers used an implant different from all the other literature - Coonrad/Morrey (Zimmer) - with similar short-term results. There are weaknesses. These outcomes have already been documented, the follow-up is short, and patient age is younger than most series; I worry about indications and the message being sent. In addition, the rigor of the data gathering, follow-up or peer review process is uncertain. Finally, the authors used their own prosthesis - does that indicate a conflict of interest? In summary, the only real value is showing similar outcomes from India as reported from the United Kingdom, Europe, Canada and the United States. This is the first paper to show such results using another implant, but this implant is not available elsewhere. The greatest concerns are the indications, care of the follow up, the younger population, and short follow-up.
Bernard F. Morrey, MD
Chairman, Department of Orthopedics
Mayo Clinic
Rochester, Minn.
Disclosure: He has no disclosures.