Ray P S, Kakarlapudi K, Rajsekhar C, Bhamra M S
Department of Orthopaedic and Trauma Surgery, Rotherham District General Hospital, Rotherham, UK.
Injury. 2000 Nov;31(9):687-92. doi: 10.1016/s0020-1383(00)00076-0.
Distal humeral fractures are difficult to treat. In the elderly population, the problems are compounded by osteoporosis and gross comminution. Open reduction and internal fixation for such fractures is sometimes difficult and may be associated with poor results. Total elbow arthroplasty has been suggested as a last-ditch effort to salvage functional use for such difficult fractures in the elderly. We followed seven patients (seven elbows) with a mean age of 81.7 years at the time of injury. Open reduction and internal fixation was considered a difficult option for these fractures. They were treated with a total elbow arthroplasty using the semi-constrained Coonrad-Morrey elbow replacement prosthesis. The duration of follow up at present is between 2 and 4 years. At the latest follow up the mean arc of flexion is 20-130 degrees. Six patients have no pain while one complains of mild pain. All elbows are stable. The Mayo elbow performance score for five elbows is excellent and two scored good. All but one patient are satisfied with the result. One patient developed superficial wound infection which resolved after antibiotic therapy. One patient has developed post-operative triceps weakness. There have been no cases of deep infection, ulnar nerve neuritis or component failure. The rarity of this procedure suggests its very narrow spectrum of indication. We feel that the short-term results do suggest an important role for semi-constrained total elbow arthroplasty in managing carefully selected comminuted distal humeral fractures in the elderly, especially those that cannot be treated by conventional open reduction and internal fixation.
肱骨远端骨折难以治疗。在老年人群体中，骨质疏松和严重粉碎性骨折使问题更加复杂。对此类骨折进行切开复位内固定有时很困难，且可能效果不佳。全肘关节置换术被建议作为挽救老年患者此类难治性骨折功能的最后手段。我们随访了7例患者（7个肘关节），受伤时平均年龄为81.7岁。对于这些骨折，切开复位内固定被认为是一个困难的选择。他们接受了使用半限制性Coonrad-Morrey肘关节置换假体的全肘关节置换术。目前随访时间为2至4年。在最近一次随访时，平均屈曲弧度为20至130度。6例患者无疼痛，1例主诉轻度疼痛。所有肘关节均稳定。5个肘关节的梅奥肘关节功能评分优秀，2个评分良好。除1例患者外，所有患者对结果满意。1例患者发生浅表伤口感染，经抗生素治疗后痊愈。1例患者出现术后三头肌无力。没有深部感染、尺神经神经炎或假体失败的病例。该手术的罕见性表明其适应证范围非常狭窄。我们认为，短期结果确实表明半限制性全肘关节置换术在治疗老年患者精心挑选的粉碎性肱骨远端骨折方面，尤其是那些无法通过传统切开复位内固定治疗的骨折，具有重要作用。
