Elbow arthroplasty is safe for the management of simple open distal humeral fractures.

Autor: Leung B; Brighton and Sussex Medical School, Brighton, UK. Electronic address: brookleung97@gmail.com., McKee M; University of Arizona College of Medicine, Phoenix, AZ, USA., Peach C; Manchester University NHS Foundation Trust, Manchester, UK., Matthews T; Cardiff and Vale University Health Board, Cardiff, UK., Arnander M; St George's University Hospitals NHS Foundation Trust, London, UK., Moverley R; University Hospitals Sussex, Brighton, UK., Murphy R; University Hospitals Sussex, Brighton, UK., Phadnis J; Brighton and Sussex Medical School, Brighton, UK; University Hospitals Sussex, Brighton, UK.
Jazyk: angličtina
Zdroj: Journal of shoulder and elbow surgery [J Shoulder Elbow Surg] 2022 May; Vol. 31 (5), pp. 1005-1014. Date of Electronic Publication: 2022 Jan 10.
DOI: 10.1016/j.jse.2021.12.005
Abstrakt: Background: Elbow arthroplasty (EA) is an established technique for the treatment of select distal humeral fractures, yet little data exists regarding the safety and outcome of EA in the presence of an open distal humeral fracture where the risk of periprosthetic infection is an even greater concern. We hypothesized that EA does not carry an increased risk of infection or other postoperative complications when performed for simple open distal humeral fractures.
Methods: Seventeen patients underwent total EA (n = 9) or hemiarthroplasty (n = 8) for an open distal humeral fracture. The open fracture component was classified according to the Orthopaedic Trauma Society system as "simple" or "complex." Outcome measures collected included the Mayo Elbow Performance Score (MEPS), range of motion, complications, and reoperations. Patients who underwent primary débridement and implantation were compared with those who underwent preliminary débridement procedures and subsequent staged arthroplasty. A systematic review of the existing literature was performed to analyze other reported cases and contextualize our findings.
Results: The mean follow-up was 46 months (range, 12-138 months). All fractures were multifragmentary and intra-articular. Sixteen patients had a "simple" open fracture and 1 had a "complex" fracture. The overall mean MEPS was 83 (range, 30-100; standard deviation ± 17), with a mean flexion-extension arc of 96°. Patients who underwent primary débridement and implantation demonstrated a higher mean flexion arc (116° vs. 79°, P = .02) than those who underwent staged arthroplasty. The mean MEPS was not significantly different between the groups (90 vs. 78, P = .12). Complications included asymptomatic ulna component loosening (n = 1), joint instability (n = 1), and symptomatic heterotopic ossification (n = 3). There were no deep or superficial infections recorded.
Conclusion: EA is safe and effective when performed for simple open distal humeral fractures. Primary débridement and implantation may offer functional benefits over a staged approach.
(Copyright © 2022 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: