Antuña Samuel A, Laakso Raúl Barco, Barrera Juan L, Espiga Xavier, Ferreres Angel
Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain.
Acta Orthop Belg. 2012 Aug;78(4):465-72.
Treatment of distal humerus fractures may be challenging, especially in the elderly patient. Total elbow replacement has been proposed as an option in selected patients. We present the results of a linked elbow replacement in 16 patients with a comminuted fracture of the distal humerus which was not considered amenable to reliable open reduction and internal fixation. At a mean follow-up of 57 months, average range of motion was from 28 degrees to 117 degrees of flexion-extension. Five patients with moderate to severe pain (31%) were not satisfied with the results of the operation. Three patients had an infection which resulted in implant removal in one patient. Eight patients had symptoms of sensory ulnar nerve neuropathy. Our results show that elbow replacement may be an optimal solution for highly comminuted osteoporotic fractures, if there are no associated complications. However, the rate of significant and minor complications such as infection or postoperative ulnar nerve symptoms is probably higher than reported. Appropriate selection of ideal candidates for this procedure and meticulous surgical technique are of paramount importance in reducing the risk of complications.
肱骨远端骨折的治疗可能具有挑战性，尤其是对于老年患者。全肘关节置换已被提议作为特定患者的一种选择。我们展示了16例肱骨远端粉碎性骨折患者行肘关节置换的结果，这些骨折被认为无法进行可靠的切开复位内固定。平均随访57个月时，屈伸活动平均范围为28度至117度。5例中度至重度疼痛患者（31%）对手术结果不满意。3例发生感染，其中1例患者因此取出了植入物。8例患者有尺神经感觉神经病变症状。我们的结果表明，如果没有相关并发症，肘关节置换可能是高度粉碎性骨质疏松性骨折的最佳解决方案。然而，感染或术后尺神经症状等严重和轻微并发症的发生率可能高于报道。正确选择该手术的理想候选人以及细致的手术技术对于降低并发症风险至关重要。
