Department of Orthopaedics, Atrium Health Musculoskeletal Institute, Charlotte, NC.
Department of Orthopaedic Surgery, OrthoCarolina, Charlotte, NC.
J Hand Surg Am. 2024 Jul;49(7):707.e1-707.e7. doi: 10.1016/j.jhsa.2022.09.007. Epub 2023 Jan 27.
The purpose of this study was to compare the rates of wound complications and heterotopic ossification (HO) between patients who underwent acute total elbow arthroplasty (TEA) and those who underwent delayed TEA performed for the treatment of distal humerus fractures. Our hypothesis was that delayed surgery will have fewer wound complications but a higher rate of HO.
We retrospectively reviewed 104 patients who had undergone TEA performed at 1 of 3 institutions following a distal humerus fracture. The acute cohort, comprising 69 patients, underwent TEA within 2 weeks; the delayed cohort, comprising 35 patients, received treatment between 2 weeks and 6 months. The rates of wound complications, HO, clinically relevant HO (requiring excision or resulting in loss of functional range of motion), and reoperation were recorded. These patients were followed up for an average of 52 (interquartile range, 18.5-117) weeks.
Wound complications occurred in 10 patients (14.5%) in the early group and 7 (20.0%) in the delayed group. The overall rate of HO was 56.7% (59 patients). The rate of clinically relevant HO was 26.0% (27 patients), which was similar between the groups. Reoperation occurred in 20 patients (19.2%), which was similar between the groups. In the early group, 3 reoperations were performed for wound complications and 4 for HO. No patients required reoperation for these indications in the delayed group. The mean flexion-extension and supination-pronation arcs were 20°-130° and 80°-80°, respectively, which were similar between the groups. Rheumatoid arthritis and younger age were associated with increased odds of wound complications and reoperation.
The rates of reoperation, wound complications, and HO were overall higher than those previously reported; however, the study was underpowered to determine a difference between early and delayed treatment.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
本研究旨在比较行急性全肘关节置换术（TEA）和延迟 TEA 治疗肱骨远端骨折患者的伤口并发症和异位骨化（HO）发生率。我们假设延迟手术的伤口并发症会更少，但 HO 的发生率会更高。
我们回顾性分析了在 3 家机构之一行 TEA 的 104 例肱骨远端骨折患者。急性组（69 例）在伤后 2 周内行 TEA；延迟组（35 例）在伤后 2 周至 6 个月内行 TEA。记录伤口并发症、HO、临床相关 HO（需要切除或导致功能活动范围丧失）和再次手术的发生率。这些患者平均随访 52 周（四分位间距 18.5-117 周）。
早期组有 10 例（14.5%）发生伤口并发症，延迟组有 7 例（20.0%）发生伤口并发症。HO 总发生率为 56.7%（59 例）。临床相关 HO 发生率为 26.0%（27 例），两组间相似。两组再次手术率均为 20.0%（20 例）。早期组有 3 例因伤口并发症再次手术，4 例因 HO 再次手术。延迟组无患者因这些指征再次手术。早期组的屈伸和旋前旋后弧分别为 20°-130°和 80°-80°，两组间相似。类风湿关节炎和年龄较小与伤口并发症和再次手术的风险增加相关。
再次手术、伤口并发症和 HO 的总体发生率高于既往报道，但本研究的样本量不足以确定早期和延迟治疗之间的差异。
研究类型/证据水平：治疗性 IV 级。
