Maman David, Ron Itay, Weishahe Nada, Keren Yaniv, Yelton Mitchell, Trior Yaniv, Apt Elad, Peskin Bezalel, Ghrayeb Nabil, Norman Doron, Shapira Jacob
The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
Orthopedic Department, Rambam Medical Center, Haifa, Israel.
J Orthop. 2025 May 6;65:191-195. doi: 10.1016/j.jor.2025.04.013. eCollection 2025 Jul.
Total elbow arthroplasties (TEA) aim to replicate anatomy and provide stability in the treatment of distal fractures of the humerus. In the presence of an aging population with higher functional demand, improving patients' well-being is crucial. This study aimed to analyze patients' reported outcomes and functional outcomes for TEA in comminuted fractures of the distal humerus and to compare these outcomes with their counterpart patients who have been treated with open reduction and internal fixation (ORIF). In addition, this study aims to compare the secondary procedures rate between the two groups.
Eligible patients were those who underwent TEA or ORIF of the distal humerus and completed several patient-reported outcome (PRO) questionnaires including the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, 12-Item Short Form Health Survey Physical and Mental components (SF-12 P and SF-12 M, respectively) scores, visual analog scale (VAS) score for pain, and patient satisfaction ratings (1-5). A physical examination including range of motion, instability, and strength was performed for all patients.
This study found that patients following TEA have shown significantly lower pain levels (TEA: 3.72 ± 2.8; ORIF 5.2 ± 2.98, P = 0.019) and higher satisfaction levels (TEA: 4.18 ± 1.17; ORIF 3.57 ± 1.46, P = 0.035) compared with patients following ORIF. DASH score (TEA: 33.7 ± 29.4; ORIF 39.75 ± 24.6, P = 0.31) and SF-12 score (TEA: 31.7 ± 9.67; ORIF 31.25 ± 10.2, P = 0.85) were not statistically different between TEA and ORIF.Patients following TEA demonstrated an advantage in flexion in the operative arm compared with patients following ORIF (P = 0.045). Both patients following TEA and ORIF demonstrated no statistically significant difference in protonation and supination of the operated elbow compared to the contralateral side. Although, a decreased range in extension and flexion of the operated elbow compared with the contralateral side was demonstrated in both groups (extension P = 0.005, flexion P < 0.001). The Grip Test showed no significant difference between the patients who were treated by TEA or ORIF (P = 0.99). Moreover, ORIF in comminuted fractures of the distal humerus in elders may be associated with a higher complication rate compared with TEA.
TEA following comminuted fractures of the distal humerus is associated with favorable satisfaction, pain levels, and range of motion in flexion compared with patients following ORIF of the distal humerus. Additionally, TEA may be associated with a lower rate of secondary procedures.
全肘关节置换术（TEA）旨在复制解剖结构并为肱骨远端骨折的治疗提供稳定性。在人口老龄化且功能需求更高的情况下，改善患者的健康状况至关重要。本研究旨在分析全肘关节置换术治疗肱骨远端粉碎性骨折患者的报告结局和功能结局，并将这些结局与其接受切开复位内固定术（ORIF）的对应患者进行比较。此外，本研究旨在比较两组的二次手术率。
符合条件的患者为接受肱骨远端全肘关节置换术或切开复位内固定术并完成多项患者报告结局（PRO）问卷的患者，这些问卷包括手臂、肩部和手部功能障碍（DASH）问卷、12项简短健康调查问卷身体和心理成分（分别为SF - 12 P和SF - 12 M）评分、疼痛视觉模拟量表（VAS）评分以及患者满意度评级（1 - 5）。对所有患者进行了包括活动范围、稳定性和力量在内的体格检查。
本研究发现，与接受切开复位内固定术的患者相比，接受全肘关节置换术的患者疼痛水平显著更低（全肘关节置换术：3.72±2.8；切开复位内固定术5.2±2.98，P = 0.019）且满意度更高（全肘关节置换术：4.18±1.17；切开复位内固定术3.57±1.46，P = 0.035）。全肘关节置换术和切开复位内固定术之间的DASH评分（全肘关节置换术：33.7±29.4；切开复位内固定术39.75±24.6，P = 0.31）和SF - 12评分（全肘关节置换术：31.7±9.67；切开复位内固定术31.25±10.2，P = 0.85）无统计学差异。与接受切开复位内固定术的患者相比，接受全肘关节置换术的患者手术侧手臂在屈曲方面具有优势（P = 0.045）。接受全肘关节置换术和切开复位内固定术的患者与对侧相比，手术侧肘关节的旋前和旋后均无统计学显著差异。尽管如此，两组患者手术侧肘关节的伸展和屈曲范围与对侧相比均有所减小（伸展P = 0.005，屈曲P < 0.001）。握力测试显示接受全肘关节置换术或切开复位内固定术治疗的患者之间无显著差异（P = 0.99）。此外，与全肘关节置换术相比，老年肱骨远端粉碎性骨折切开复位内固定术可能与更高的并发症发生率相关。
与肱骨远端切开复位内固定术的患者相比，肱骨远端粉碎性骨折后行全肘关节置换术的患者满意度更高、疼痛水平更低且屈曲活动范围更佳。此外，全肘关节置换术可能与更低的二次手术率相关。
