Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany.
Eur J Trauma Emerg Surg. 2022 Oct;48(5):3941-3947. doi: 10.1007/s00068-022-01921-2. Epub 2022 Mar 5.
Total elbow arthroplasty (TEA) has evolved over the last years, with satisfactory early results, mainly not only in degenerative arthritis, but also increasingly after trauma. Outcome studies in recently published papers are mainly based on the range of motion (ROM), complication rate as well as patient-reported outcome scales and questionnaires. The purpose of this study was to add a new perspective with the "Purdue Pegboard" skill tests in a homogenous set of elderly trauma patients to contribute to a more precise objective outcome measurement in this specific population.
A retrospective review was performed on a consecutive cohort of all patients with age above 60 years that received TEA after trauma. Data from follow-up examinations over a standardized time-schedule within 2 years after TEA were included. Mayo Elbow Performance Score (MEPS), "Disability of Arm, Shoulder and Hand" (DASH) Questionnaire, ROM as well as test-scores using the Pegboard test were evaluated.
Mean age was 76.0 years ± 10.3. Indications for TEA were posttraumatic arthrosis in 68.8% (n = 11) and extensive fractures that could not be reconstructed surgically in 31.3% (n = 5). The mean score of MEPS was 82.81 ± 16.63 and 29.18 ± 12.01 in the DASH. ROM presented with a mean of 109.7° ± 15.4. Patients demonstrated good, but marginally reduced test scores in the Pegboard skill tests in comparison with the healthy reference population. No relevant differences between the arm with and the arm without TEA (0.3 ± 3.6; p = 0.715) were noted after 2 years.
In the elderly trauma patient with complex fractures of the elbow, TEA is a good alternative to joint reconstruction using various osteosynthesis techniques. TEA is able to avoid revision surgery after open reduction and internal fixation of complex fractures. In cases of failed reconstruction, it is also a viable secondary procedure in posttraumatic arthrosis. Good outcomes in functionality and dexterity can be achieved. Skill tests like the Purdue Pegboard could add a valuable perspective in assessing functional outcomes after TEA.
全肘关节置换术（TEA）近年来不断发展，早期结果令人满意，不仅主要适用于退行性关节炎，而且越来越多地适用于创伤后。最近发表的论文中的研究结果主要基于活动范围（ROM）、并发症发生率以及患者报告的结果量表和问卷。本研究的目的是在一组同质的老年创伤患者中增加使用“Purdue 钉板”技能测试的新视角，以更精确地测量该特定人群的客观结果。
对一组连续的 60 岁以上因创伤接受 TEA 的患者进行回顾性分析。纳入 TEA 后 2 年内按标准化时间表进行随访检查的数据。评估 Mayo 肘关节功能评分（MEPS）、“手臂、肩部和手残疾”（DASH）问卷、ROM 以及使用钉板测试的测试分数。
平均年龄为 76.0±10.3 岁。TEA 的适应证为创伤后关节炎 68.8%（n=11）和无法手术重建的广泛骨折 31.3%（n=5）。MEPS 的平均得分为 82.81±16.63，DASH 的平均得分为 29.18±12.01。ROM 平均为 109.7°±15.4。与健康对照组相比，患者在钉板技能测试中表现出良好但略有降低的测试分数。2 年后，TEA 侧与非 TEA 侧之间（0.3±3.6；p=0.715）无明显差异。
在肘部复杂骨折的老年创伤患者中，TEA 是各种内固定技术关节重建的良好替代方法。TEA 能够避免复杂骨折切开复位内固定后的翻修手术。在重建失败的情况下，它也是创伤后关节炎的可行二次手术。可以实现良好的功能和灵巧度。像 Purdue 钉板这样的技能测试可以在评估 TEA 后的功能结果方面提供有价值的视角。
