Batten Timothy J, Sin-Hidge Claire, Brinsden Mark D, Guyver Paul M
Department of Trauma and Orthopaedics, Derriford Hospital, Plymouth, PL6 8DH, UK.
Eur J Orthop Surg Traumatol. 2018 Jan;28(1):23-27. doi: 10.1007/s00590-017-2006-9. Epub 2017 Jun 28.
Comminuted distal humerus fractures in the elderly have traditionally been managed by ORIF or total elbow arthroplasty (TEA). This poses a treatment dilemma in elderly patients where anaesthetic and surgical risks combine with poor bone and wound healing. We aimed to assess the functional outcomes in patients managed non-operatively, with TEA being used as the salvage procedure. Retrospective analysis of patients over 65 years presenting to our unit between 2005 and 2015 was undertaken. Sixty-two patients were identified, 38 had died, and 5 were lost to follow-up leaving 5 with immediate TEA and 14 non-operatively managed, available for review. Mean follow-up was 55 months (range 17-131). Patient outcomes were measured using VAS scores for pain at rest and during activity, and the Oxford elbow score (OES) for TEA and non-operatively managed patients. Conversion to TEA for non-operative treatment and complications were also recorded. Notes interrogation of patients who had died or were lost to follow-up to ascertain outcomes was undertaken. The mean age at injury was 76 years (range 65-90) of which 79% (11/14) were females. The mean score on the OES was 46.2 (range 29-48). The mean VAS score at rest was 0.4 (range 0-6), and the mean VAS score during activity was 1.3 (range 0-9). 93% (13/14) of patients reported no pain in their injured elbow at rest and 79% (11/14) reported no pain during activity. No patients converted to TEA, and there were no complications. Of deceased patients, notes demonstrated one who had ongoing stiffness after physiotherapy, but no conversions to TEA were undertaken. Those managed primarily with TEA had worse OES (mean 40.8), but slightly better pain scores with means 0.2 at rest and 0.8 at activity. Non-operative management of comminuted distal humerus fractures should be considered for elderly patients, avoiding surgical risks whilst giving satisfactory functional outcomes in this low-demand group.
老年肱骨远端粉碎性骨折传统上采用切开复位内固定术（ORIF）或全肘关节置换术（TEA）治疗。对于老年患者而言，这带来了一个治疗难题，因为麻醉和手术风险叠加了骨骼和伤口愈合不良的问题。我们旨在评估非手术治疗患者的功能结局，将TEA用作挽救性手术。对2005年至2015年间到我院就诊的65岁以上患者进行了回顾性分析。共确定62例患者，38例死亡，5例失访，剩余5例行即刻TEA，14例接受非手术治疗，可供评估。平均随访时间为55个月（范围17 - 131个月）。使用静息和活动时疼痛的视觉模拟评分（VAS）以及TEA和非手术治疗患者的牛津肘关节评分（OES）来衡量患者结局。还记录了非手术治疗转为TEA的情况及并发症。对死亡或失访患者进行病历审查以确定结局。受伤时的平均年龄为76岁（范围65 - 90岁），其中79%（11/14）为女性。OES的平均评分为46.2（范围29 - 48）。静息时VAS平均评分为0.4（范围0 - 6），活动时VAS平均评分为1.3（范围0 - 9）。93%（13/14）的患者报告受伤肘部静息时无疼痛，79%（11/14）的患者报告活动时无疼痛。无患者转为TEA，且无并发症。在已故患者中，病历显示有1例物理治疗后仍存在僵硬，但未转为TEA。主要接受TEA治疗的患者OES较差（平均40.8），但疼痛评分稍好，静息时平均为0.2，活动时平均为0.8。对于老年患者，应考虑对肱骨远端粉碎性骨折进行非手术治疗，避免手术风险，同时在这个低需求群体中获得令人满意的功能结局。
