Primary Elbow Arthroplasty in the Management of Complex Distal Humerus Fractures.

Autor:	Mahajan UD; Trauma and Orthopedics, Queen Elizabeth Hospital Birmingham, Birmingham, GBR., Memon K; Trauma and Orthopedics, Queen Elizabeth Hospital Birmingham, Birmingham, GBR., Mehta S; Trauma and Orthopedics, Glan Clwyd Hospital, Rhyl, GBR., Chan S; Trauma and Orthopedics, Queen Elizabeth Hospital Birmingham, Birmingham, GBR., Spurrier E; Trauma and Orthopedics, Queen Elizabeth Hospital Birmingham, Birmingham, GBR., Kalogrianitis S; Trauma and Orthopedics, Queen Elizabeth Hospital Birmingham, Birmingham, GBR.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2024 Jul 31; Vol. 16 (7), pp. e65851. Date of Electronic Publication: 2024 Jul 31 (Print Publication: 2024).
DOI:	10.7759/cureus.65851
Abstrakt:	Introduction Complex distal humerus fractures pose significant challenges in orthopedic surgery, especially when traditional open reduction and internal fixation (ORIF) is not feasible. Primary elbow arthroplasty has emerged as an alternative treatment option for these fractures, but its application remains limited. This study aimed to evaluate the functional outcomes, patient selection criteria, and follow-up results of primary elbow arthroplasty in the management of complex distal humerus fractures. Methods A retrospective review was conducted on 15 patients who underwent primary elbow arthroplasty for Orthopaedic Trauma Association (OTA) type C distal humerus fractures between 2017 and 2023 at our institution. Inclusion criteria were patients aged 18 years or older who were offered either total elbow or hemiarthroplasty for acute complex distal humerus fracture. Data were collected from patient medical records, including demographic information, fracture classification, surgical details, and postoperative follow-up. Functional outcomes were assessed using the Oxford Elbow Score (OES) and Mayo Elbow Performance Score (MEPS). Complications were documented, and descriptive statistics were used to summarise the findings. Results The mean age of the patients was 71.8 years (IQR 17 years), with 12 females and three males. The mean time to surgery was 14.7 days post-injury (IQR: 12 days). The mean follow-up duration was 52 weeks (range: 8-234 weeks, IQR: 27 weeks) and variability was noted. The mean flexion-extension arc at the final follow-up was 93° (IQR: 32.5°). The mean OES was 46 (IQR: 22), and the mean MEPS was 75 (IQR: 37), indicating good to excellent functional outcomes. Scores for two patients were not available due to dementia. Reported complications included one case of ulnar sensory symptoms and one case requiring metalwork removal following olecranon osteotomy. Conclusion Primary elbow arthroplasty provides a viable treatment option for complex distal humerus fractures, demonstrating significant functional improvements and high patient satisfaction. However, the variability in follow-up and subjective decision-making underscores the need for standardized protocols. Future multicenter, prospective studies with larger cohorts and standardized follow-up protocols are recommended to confirm these findings and optimize patient care. Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. University Hospitals Birmingham NHS Foundation Trust issued approval Exempt. This study is a clinical audit (UHB audit code: 17846), hence, it does not require ethical approval. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Mahajan et al.)
Databáze:	MEDLINE
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