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International Orthopaedics
Published in: International Orthopaedics 4/2015

01-04-2015 | Original Paper

Arthroplasty compared to internal fixation by locking plate osteosynthesis in comminuted fractures of the distal humerus

Authors: Alexander Ellwein, Helmut Lill, Christine Voigt, Pauline Wirtz, Gunnar Jensen, Jan Christoph Katthagen

Published in: International Orthopaedics | Issue 4/2015

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Abstract

Purpose

The purpose of this study was to evaluate and compare the results after double locking plate osteosynthesis (ORIF) and total elbow arthroplasty (TEA) in AO type C fractures of the distal humerus.

Methods

This retrospective study includes clinical results of 29 patients (9xTEA, 20xORIF) with a mean age of 62 years. The male to female ratio was 8:21. Range of motion, MEPS, DASH and complications were evaluated. Patients older than 60 years (n = 19) were filtered and compared statistically.

Results

After a mean follow-up of 25 months the ORIF-group reached an extension-flexion of 99°±23° and the TEA-group of 111°±13°. The ORIF-group vs. the TEA-group had a mean MEPS of 85±17 vs. 94±11 and DASH of 34±24 vs. 24±12. In patients older than 60 years extension-flexion was 97°±23° after ORIF and 110°±14 after TEA (p = 0.237). The ORIF-group vs. the TEA-group had a mean MEPS of 82±21 vs. 94±11 (p = 0.078) and DASH of 45±18 vs. 26±11 (p = 0.023). The ORIF-group had a 4.4 times higher risk for major complications.

Conclusion

TEA and ORIF lead to comparable functional results, but major complications are more common after ORIF. Despite this, ORIF remains the gold standard for younger and older patients because of the lifelong loading limitation after TEA, unknown implant survival and problematic revision surgery. For patients older than 60 years a primary TEA can be recommended in exceptional cases, if the loading limitation is acceptable for the individual or the fracture is not reconstructable.
Literature
1.
Robinson CM, Hill RMF, Jacobs N et al (2003) Adult distal humeral metaphyseal fractures: epidemiology and results of treatment. J Orthop Trauma 17:38–47CrossRefPubMed
2.
Palvanen M, Kannus P, Niemi S, Parkkari J (2010) Secular trends in distal humeral fractures of elderly women: nationwide statistics in Finland between 1970 and 2007. Bone 46:1355–1358CrossRefPubMed
3.
Korner J, Diederichs G, Arzdorf M et al (2004) A biomechanical evaluation of methods of distal humerus fracture fixation using locking compression plates versus conventional reconstruction plates. J Orthop Trauma 18:286–293CrossRefPubMed
4.
Schmidt-Horlohé KH, Bonk A, Wilde P et al (2013) Promising results after the treatment of simple and complex distal humerus type C fractures by angular-stable double-plate osteosynthesis. Orthop Traumatol Surg Res 99:531–541CrossRefPubMed
5.
Clavert P, Ducrot G, Sirveaux F et al (2013) Outcomes of distal humerus fractures in patients above 65 years of age treated by plate fixation. Orthop Traumatol Surg Res 99:771–777CrossRefPubMed
6.
Schuster I, Korner J, Arzdorf M et al (2008) Mechanical comparison in cadaver specimens of three different 90-degree double-plate osteosyntheses for simulated C2-type distal humerus fractures with varying bone densities. J Orthop Trauma 22:113–120CrossRefPubMed
7.
Zalavras CG, Vercillo MT, Jun B-J et al (2011) Biomechanical evaluation of parallel versus orthogonal plate fixation of intra-articular distal humerus fractures. J Should Elbow Surg 20:12–20CrossRef
8.
Shin S-J, Sohn H-S, Do N-H (2010) A clinical comparison of two different double plating methods for intraarticular distal humerus fractures. J Should Elbow Surg 19:2–9CrossRef
9.
Hackl M, Wegmann K, Bartsch V et al (2014) Impingement of the posterolateral humeral plate. Landmarks for prevention in double-plate osteosynthesis of distal humeral fractures. Obere Extremität 9:186–191CrossRef
10.
Korner J, Lill H, Müller LP et al (2003) The LCP-concept in the operative treatment of distal humerus fractures–biological, biomechanical and surgical aspects. Injury 34(Suppl 2):B20–30CrossRefPubMed
11.
Mansat P, Nouaille Degorce H, Bonnevialle N et al (2013) Total elbow arthroplasty for acute distal humeral fractures in patients over 65 years old—results of a multicenter study in 87 patients. Orthop Traumatol Surg Res 99:779–784CrossRefPubMed
12.
Ducrot G, Ehlinger M, Adam P et al (2013) Complex fractures of the distal humerus in the elderly: is primary total elbow arthroplasty a valid treatment alternative? A series of 20 cases. Orthop Traumatol Surg Res 99:10–20CrossRefPubMed
13.
Plaschke HC, Thillemann TM, Brorson S, Olsen BS (2014) Implant survival after total elbow arthroplasty: a retrospective study of 324 procedures performed from 1980 to 2008. J Should Elbow Surg 23:829–836CrossRef
14.
Müller M, Nazarian S, Koch P, Schatzker J (1990) The comprehensive classification of fractures of long bones. Springer, BerlinCrossRef
15.
Oestern HJ, Tscherne H (1983) Pathophysiology and classification of soft tissue damage in fractures. Orthopade 12:2–8PubMed
16.
Athwal GS, Hoxie SC, Rispoli DM, Steinmann SP (2009) Precontoured parallel plate fixation of AO/OTA type C distal humerus fractures. J Orthop Trauma 23:575–580CrossRefPubMed
17.
Greiner S, Haas NP, Bail HJ (2008) Outcome after open reduction and angular stable internal fixation for supra-intercondylar fractures of the distal humerus: preliminary results with the LCP distal humerus system. Arch Orthop Trauma Surg 128:723–729CrossRefPubMed
18.
Obert L, Ferrier M, Jacquot A et al (2013) Distal humerus fractures in patients over 65: complications. Orthop Traumatol Surg Res 99:909–913CrossRefPubMed
19.
Garcia JA, Mykula R, Stanley D (2002) Complex fractures of the distal humerus in the elderly. The role of total elbow replacement as primary treatment. J Bone Joint Surg (Br) 84:812–816CrossRef
20.
Gambirasio R, Riand N, Stern R, Hoffmeyer P (2001) Total elbow replacement for complex fractures of the distal humerus. An option for the elderly patient. J Bone Joint Surg (Br) 83:974–978CrossRef
21.
Cobb TK, Morrey BF (1997) Total elbow arthroplasty as primary treatment for distal humeral fractures in elderly patients. J Bone Joint Surg Am 79:826–832PubMed
22.
Ries C, Wegmann K, Hackl M et al (2014) Secondary total elbow arthroplasty after distal humeral fracture. Obere Extremität 9:156–162CrossRef
23.
Frankle MA, Herscovici D, DiPasquale TG et al (2003) A comparison of open reduction and internal fixation and primary total elbow arthroplasty in the treatment of intraarticular distal humerus fractures in women older than age 65. J Orthop Trauma 17:473–480CrossRefPubMed
24.
McKee MD, Veillette CJH, Hall JA et al (2009) A multicenter, prospective, randomized, controlled trial of open reduction–internal fixation versus total elbow arthroplasty for displaced intra-articular distal humeral fractures in elderly patients. J Should Elbow Surg 18:3–12CrossRef
25.
Egol KA, Tsai P, Vazques O, Tejwani NC (2011) Comparison of functional outcomes of total elbow arthroplasty vs plate fixation for distal humerus fractures in osteoporotic elbows. Am J Orthop (Belle Mead NJ) 40:67–71
26.
Foruria AM, Sanchez-Sotelo J, Oh LS et al (2011) The surgical treatment of periprosthetic elbow fractures around the ulnar stem following semiconstrained total elbow arthroplasty. J Bone Joint Surg Am 93:1399–1407CrossRefPubMed
27.
Sanchez-Sotelo J, O’Driscoll S, Morrey BF (2002) Periprosthetic humeral fractures after total elbow arthroplasty: treatment with implant revision and strut allograft augmentation. J Bone Joint Surg Am 84-A:1642–1650PubMed
28.
Obremskey WT, Bhandari M, Dirschl DR, Shemitsch E (2003) Internal fixation versus arthroplasty of comminuted fractures of the distal humerus. J Orthop Trauma 17:463–465CrossRefPubMed
Metadata
Title
Arthroplasty compared to internal fixation by locking plate osteosynthesis in comminuted fractures of the distal humerus
Authors
Alexander Ellwein
Helmut Lill
Christine Voigt
Pauline Wirtz
Gunnar Jensen
Jan Christoph Katthagen
Publication date
01-04-2015
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 4/2015
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-014-2635-0

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