Orthopaedic and Trauma Surgery Department, Hautepierre Hospital, Strasbourg University Hospitals, 1, avenue Molière, 67098 Strasbourg, France.
Orthop Traumatol Surg Res. 2013 Feb;99(1):10-20. doi: 10.1016/j.otsr.2012.10.010. Epub 2012 Dec 27.
Distal humerus fractures are fairly rare. But as our population ages, these fractures become more complex and the choice of treatment more delicate. Poor bone quality results in many technical problems and the fixation hardware stability remains at risk. The goal of this study was to evaluate the functional recovery and morbidity of complex distal humerus fractures in elderly patients when treated with elbow prosthesis.
Good functional recovery can be achieved with a total joint replacement.
This series consisted of 20 patients (18 women and two men) having an average age of 80years (range 65-93, median 80). Based on the AO classification, there were two Type A2 fractures, two Type B fractures, 15 Type C fractures and one fracture that could not be classified because of previous rheumatoid disease history at this elbow. Two fractures were open. In two cases, the olecranon was also fractured. Treatment consisted of the implantation of a Coonrad-Morrey, hinge-type total elbow prosthesis (Zimmer(®), Warsaw, IN, USA). The Mayo Clinic surgical approach was used 17 times and the transolecranon approach was used three times. Primary arthroplasty was performed in 19 cases and the surgery was performed after six weeks of conservative treatment (diagnostic delay) in one case. Unrestricted motion was allowed after surgery, but a maximum of 0.5kg could be carried during the first 3months; this was subsequently increased to 2.5kg.
Fifteen of the 20 patients were available for reevaluation with an average follow-up of 3.6years (range 1.7-5.5, median 3.4). Four patients had died and one was lost to follow-up. The average range of motion was 97° (range 60-130°), comprising an average flexion of 130° (range 110-140°) and average loss of extension of 33° (range 0-80°). Pronation and supination were normal. The average Mayo Elbow Performance Score (MEPS) was 83 (range 60-100, median 80). X-rays revealed seven cases of radiolucent lines, with two being progressive. There was no visible wear of the polyethylene bushings at the hinge. Six patients had moderate periarticular heterotopic ossification. The two cases of olecranon osteotomy and one case of olecranon fracture had healed. There were no surgical site infections but two cases of ulnar compression, one of which required neurolysis. There was one case of humeral component loosening after 6years, but the implant was not changed.
The clinical range of motion results were comparable to published data. The functional scores were slightly lower, mainly because of the pain factor. The initial results were encouraging and consistent with published data as long as the indications were well-chosen. Based on this retrospective study, total elbow arthroplasty can be a valid alternative in the surgeon's treatment armamentarium for complex distal humerus fractures in elderly patients who have moderate functional demands. Our results support our hypothesis, since we found good functional recovery without associated morbidity.
Level IV retrospective study without comparator.
肱骨远端骨折较为少见。但随着人口老龄化，这些骨折变得更加复杂，治疗选择也更加微妙。骨质量差会导致许多技术问题，固定硬件的稳定性仍然存在风险。本研究的目的是评估在老年患者中使用肘部假体治疗复杂肱骨远端骨折的功能恢复和发病率。
全关节置换可获得良好的功能恢复。
本系列包括 20 名患者（18 名女性和 2 名男性），平均年龄 80 岁（范围 65-93，中位数 80）。根据 AO 分类，有两例 A2 型骨折，两例 B 型骨折，15 例 C 型骨折，一例因既往类风湿病史无法分类。两处骨折为开放性。有两例尺骨鹰嘴也骨折。治疗包括植入 Coonrad-Morrey 铰链式全肘假体（Zimmer（®），印第安纳州华沙）。17 例采用 Mayo 临床入路，3 例采用经鹰嘴入路。19 例进行了初次关节置换，1 例在保守治疗 6 周（诊断延迟）后进行了手术。术后允许不受限制地活动，但在前 3 个月内最多只能携带 0.5kg，随后增加到 2.5kg。
20 名患者中有 15 名可进行重新评估，平均随访 3.6 年（范围 1.7-5.5，中位数 3.4）。有 4 名患者死亡，1 名患者失访。平均活动范围为 97°（范围 60-130°），包括平均屈曲 130°（范围 110-140°）和平均丧失伸展 33°（范围 0-80°）。旋前和旋后正常。平均 Mayo 肘部功能评分（MEPS）为 83（范围 60-100，中位数 80）。X 线片显示 7 例存在透亮线，其中 2 例为进行性。铰链处的聚乙烯衬垫无明显磨损。6 例有中度关节周围异位骨化。鹰嘴截骨术的 2 例和鹰嘴骨折的 1 例均已愈合。无手术部位感染，但有 2 例尺神经受压，其中 1 例需要神经松解。6 年后有 1 例肱骨组件松动，但未更换。
临床活动范围结果与已发表的数据相当。功能评分略低，主要是因为疼痛因素。初始结果令人鼓舞，与已发表的数据一致，只要选择的适应证恰当。基于这项回顾性研究，全肘置换术可为有中度功能需求的老年患者治疗复杂肱骨远端骨折提供有效的治疗手段。我们的结果支持我们的假说，因为我们发现了良好的功能恢复，且没有相关的发病率。
无对照的 IV 级回顾性研究。
