Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia.
King Saud University College of Medicine, Riyadh, Saudi Arabia.
Clin Orthop Surg. 2020 Dec;12(4):503-513. doi: 10.4055/cios20012. Epub 2020 Jul 21.
The treatment of distal humerus fractures is often challenging in osteoporotic elderly patients. Total elbow arthroplasty (TEA) is a salvage option for non-reconstructable fractures. The aim of this systematic review was to evaluate the clinical evidence for primary TEA in patients with acute distal humeral fractures.
Literatures were searched through PubMed, Ovid/Medline, Cochrane, Google Scholar, and Embase databases with the keywords, "distal humerus fracture," "total elbow arthroplasty," and "outcome" according to the MeSH (Medical Subject Headings) index for English-language studies published from April 2009 to April 2019. We performed a systematic review using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.
Ten articles with a total of 269 patients were included in the review. The Bryan-Morrey approach was the most common surgical approach (33.7%) with triceps reflecting (42%) for triceps tendon management. The most common implant design used was the Coonrad-Morrey system (83%). The mean postoperative motion arc was 102.3° for flexion-extension and 145.8° for pronation-supination. The average functional outcome score was 89.5 with Mayo Elbow Performance Score (MEPS). An excellent MEPS was found in studies with less than 7 days of average time from injury to surgery. The overall complication rate was 21.5%.
The current review showed favorable outcome of primary linked TEA for acute distal humerus fractures. Despite the promising functional outcomes, the complication rate was still considerably high. This systematic review will give surgeons help in explaining to patients regarding the expected outcome after primary TEA for acute distal humerus fractures.
骨质疏松老年患者的肱骨远端骨折治疗往往具有挑战性。全肘关节置换术（TEA）是不可重建骨折的挽救措施。本系统评价的目的是评估急性肱骨远端骨折患者初次 TEA 的临床证据。
通过 PubMed、Ovid/Medline、Cochrane、Google Scholar 和 Embase 数据库，使用 MeSH（医学主题词）索引中的关键词“肱骨远端骨折”、“全肘关节置换术”和“结果”，搜索 2009 年 4 月至 2019 年 4 月发表的英文文献。我们使用系统评价和荟萃分析的首选报告项目（PRISMA）指南进行了系统评价。
纳入了 10 篇文章，共 269 例患者。Bryan-Morrey 入路是最常见的手术入路（33.7%），三头肌反射（42%）用于三头肌腱管理。最常用的植入物设计是 Coonrad-Morrey 系统（83%）。屈伸运动的平均术后运动弧为 102.3°，旋前-旋后为 145.8°。平均功能结果评分为 89.5，Mayo 肘功能评分（MEPS）。在从受伤到手术的平均时间少于 7 天的研究中，MEPS 结果优秀。总的并发症发生率为 21.5%。
目前的综述显示，急性肱骨远端骨折初次使用链接 TEA 的效果良好。尽管功能结果很有前景，但并发症发生率仍然相当高。本系统评价将帮助外科医生向患者解释初次 TEA 治疗急性肱骨远端骨折的预期结果。
