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Elbow hemiarthroplasty for distal humerus fractures yielded successful outcomes
NEW YORK — Patients with comminuted intra-articular distal humerus fractures who underwent elbow hemiarthroplasty experienced good, early successful functional outcomes, according to results presented here.
Mark A. Schrumpf, MD, and colleagues obtained preoperative radiographs and CT scans of eight patients with comminuted intra-articular distal humerus fractures who underwent elbow hemiarthroplasty between 2015 and 2019. Schrumpf noted that a triceps-on approach was used in all cases. Researchers evaluated patient records, radiographs and physical exams for postoperative pain, function, stability, satisfaction and complications, and limitations of elbow function postoperatively were determined by the Mayo Elbow Performance Score.
Despite a 100% follow-up rate, Schrumpf noted three patients were excluded due to insufficient follow-up.
“Of the five patients we did get back for follow-up, their average age was 71 years and 100% of them were females, speaking to the potential for osteoporosis,” Schrumpf said in his presentation at the American Shoulder and Elbow Surgeons Annual Meeting. “The average follow-up in these patients was just short of 3 years.”
Schrumpf noted patients had excellent range of motion with 130° of flexion, 17° of extension, and near full supination and pronation. He added patients had a Mayo Elbow Performance Score of 88.3. Although the study cohort experienced no complications, Schrumpf noted one of the three excluded patients had a repeat fall before the 1-year mark and was revised to a total elbow arthroplasty with the insertion of an ulnar component with retention of the humeral component.
“We had no further complications in this patient, and she went on to do well after her second surgical session,” Schrumpf said. – by Casey Tingle
Reference:
Schrumpf MA, et al. Paper 15. Presented at: American Shoulder and Elbow Surgeons Annual Meeting; Oct. 17-19, 2019; New York.
Disclosure: Schrumpf reports he receives IP royalties from Shoulder Innovations.
Perspective
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This is a retrospective case series evaluating outcomes for five elderly patients who underwent hemiarthroplasty for comminuted, intra-articular distal humerus fractures. This injury can be challenging to treat with open reduction and internal fixation, and total elbow arthroplasty requires life-long postoperative weight-bearing restrictions that can be very limiting for most patients. Therefore, hemiarthroplasty is an appealing procedure, as it definitively reconstructs the injured bearing surface without the postoperative restrictions required with total elbow replacement.
Of the five patients included in this study, the authors reported an excellent postoperative Mayo Elbow Performance Score of 88.3, an arc of motion between 17° and 130°, and no reoperations in these patients after 3-year follow up. Although limited by a small sample size of only five patients, the exclusion of another three patients due to follow-up limitations (one requiring reoperation), and limited study end point of only 3 years, this cohort does demonstrate the potential benefit that this treatment may offer for select patients with these challenging injuries. It should be noted that elbow hemiarthroplasty for fracture is still presently considered off-label in the United States.
Disorders of the shoulder and elbow
Arvada, Colorado
Perspective
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In the paper by Mark A. Schrumpf, MD, and colleagues, there were five patients who they felt were ideal candidates for elbow hemiarthroplasty. These were elderly, low-demand patients with a capacity to adhere to postoperative restrictions. Their follow-up was just over 2 years. For arthroplasty, that is not a long-term follow-up, but the patients average age was almost 72 years.
If you look at previously published reports on hemiarthroplasty, range of motion is not as good as a total elbow arthroplasty. In this study it was 17° to 130°, which is about average for hemiarthroplasty. Typically, a total elbow arthroplasty offers better range of motion and pain relief overall. Their Mayo Elbow Performance score was very good. Importantly, there were no cases of subsidence, ulnar wear or hardware loosening.
Although there were small numbers in this series, hemiarthroplasty is a reasonable treatment for select patients. In the United States, however, this remains an off-label use. Products specifically designed for elbow hemiarthroplasty are available in other countries.
University of Tennessee
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