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Elbow arthroplasty an option for humeral fractures in the elderly
Complications directly attributed to surgery included one removal of a K wire and one wound debridement.
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Total elbow arthroplasty may be a reliable treatment option for distal humeral fractures in elderly patients who have compromised osteosynthesis, according to a review of Mayo Clinic data.
Srinath Kamineni, MD, an orthopedic surgeon in the United Kingdom, and Bernard F. Morrey, MD, an orthopedic surgeon at the Mayo Clinic in Rochester, Minn., retrospectively studied the Mayo Clinic experience in total elbow arthroplasty on elderly patients with distal humerus fractures. Their study included 43 acute fractures among 43 patients who had an average age of 67 years.
Most patients (77%) had AO type C fractures, “which are comminuted distal humerus fractures involving the articular surface,” said Kamineni, who presented the results of the study at the American Academy of Orthopaedic Surgeons 72nd Annual Meeting. Of the remaining 10 patients, five had AO type A fractures and five had type B, he said.
Postoperative follow-up averaged seven years, with no patients followed for less than two years. Twenty-nine patients also had coexisting comorbidities at the time of treatment, he noted.
During follow-up, all except 14 deceased patients had undergone clinical and radiographic evaluations. For the 14 deceased patients, the researchers included only data from the patients’ charts.
“The results showed that on average the range of motion was just about acceptable, with an average extension deficit of 24º and an average flexion of 132º, the minimum being about 100º,” Kamineni said.
Overall, postoperative Mayo Elbow Performance Score (MEPS) averaged 93 out of 100. “Breaking down the different age groups, patients under 45 years old had a marginally worse elbow performance score than the remainder of patients. But this was not statistically significant,” Kamineni said.
Most patients — 65% — did not experience any major complications, but 10 patients had a postoperative complication that required some sort of surgical intervention.
“One of these patients fell and sustained a humeral fracture through the ... beaded stem, which is due to the titanium sensitivity to the beads themselves,” Kamineni said.
Other complications included one ulnar component fracture, one two-stage ulnar revision, one case of aseptic loosening at nine years postop and one revision due to aseptic arthritis, according to the study.
Regarding complications directly attributed to surgery, one patient required removal of a K wire and one patient required wound debridement.
Minor complications included one case of finger diastasis, one ulnar nerve neuropraxia, one case of reflex sympathetic dystrophy and one superficial wound infection. All of these cases resolved with relatively conservative measures, Kamineni said.
For more information:
- Kamineni S, Morrey BF. Distal humeral fractures treated with non-custom total elbow arthroplasty: 7 year follow-up. #389. Presented at the American Academy of Orthopaedic Surgeons 72nd Annual Meeting. Feb. 23-27, 2005. Washington.