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Arthroplasty in Elbow Fracture Treatment
Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences.
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Open reduction and internal fixation is the treatment of choice for distal humeral fractures. Stable fixation is required to allow early mobilisation and to reduce the risk of poor functional results. In an elderly patient with osteoporotic bone and with a comminuted intra-articular fracture stable internal fixation can be difficult to achieve. In these cases elbow arthroplasty is an option.

An irreparable radial head fracture can be treated by excision or replacement. The indications for the respective procedure are unclear since reports include an array of different associated soft-tissue and bony injuries.

The aim of this thesis was to evaluate the use, complication rates and functional outcome of elbow arthroplasty as primary treatment for complex distal humeral fractures and assess the usefulness of radial head replacement in Mason IV fracture dislocations.

50 patients, aged 56-89 years were treated for a distal humeral fracture with primary hemi-arthroplasty using the Kudo© humeral component or the Latitude® prosthesis. The functional outcome was assessed retrospectively. The majority of the 50 patients treated with a primary hemi-arthroplasty for a distal humeral fracture had a good or excellent functional result and regained a functional arc of movement of at least 100 degrees at medium term follow-up. There were six patients suffering secondary surgery and two with persistent ulnar nerve symptoms. Wear of the olecranon fossa was seen, mainly in the eight patients treated with a non-anatomical implant (Kudo®). Functional results were comparable to total elbow arthroplasty and open reduction and internal fixation (ORIF) for distal humeral fractures. The use of implants that are more anatomical seemed to reduce the degree of olecranon wear but long-term results are lacking.

The nationwide use of primary arthroplasty for a distal humeral fracture between 1999 and 2014 was examined using three different registers. The survival rates in relation to prosthetic desing, age and sex were investigated using Cox regression analysis and number of adverse events recorded.

In total 405 patients were treated with primary arthroplasty for a distal humeral fracture. The mean age at surgery was 75 years and the mean observation time was 67 months. Eighteen patients had undergone revision surgery and another 26 patients suffered an adverse event, 24 of which required secondary surgery.

Increasing age reduced the risk for revision and there was no significant difference in survival between total- and hemi arthroplasty. The cumulative survival rate at 5 years was 99% (CI 98-100) and at 10 years 90% (CI 85-96). Elbow arthroplasty as primary treatment for distal humeral fractures produced reliable results with regards to revision surgery and adverse events.

18 patients, age 19-79 years, treated with radial head replacement, and 14 patients, age 29-70 years, treated with radial head resection, for a Mason IV fracture dislocation were retrospectively reviewed.

There were no significant differences in functional outcome in patients treated with replacement or excision for a Mason IV fracture dislocation. The rate of secondary surgery was higher in patients treated with replacement and ulno-humeral osteoarthritis was more pronounced in patients treated with radial head excision but follow-up was longer in these patients. Functional results were not improved by using radial head arthroplasty for Mason IV fracture dislocation. Secondary osteoarthritis is a concern in patients treated with excision but did not affect functional outcome after a mean follow-up time of 108 months.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2018. , p. 122
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1610
National Category
Orthopaedics
Identifiers
URN: urn:nbn:se:liu:diva-145284DOI: 10.3384/diss.diva-145284ISBN: 9789176853573 (print)OAI: oai:DiVA.org:liu-145284DiVA, id: diva2:1184171
Public defence
2018-03-23, Berzeliussalen, Ingång 64, plan 9, Campus US, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2018-02-20 Created: 2018-02-20 Last updated: 2019-09-30Bibliographically approved
List of papers
1. The Kudo humeral component as primary hemiarthroplasty in distal humeral fractures
Open this publication in new window or tab >>The Kudo humeral component as primary hemiarthroplasty in distal humeral fractures
2012 (English)In: Journal of shoulder and elbow surgery, ISSN 1058-2746, E-ISSN 1532-6500, Vol. 21, no 4, p. 451-455Article in journal (Refereed) Published
Abstract [en]

Background: Treatment of intra-articular fractures of the distal humerus in the elderly is challenging. In patients with very distal fractures and severe comminution, primary arthroplasty has been advocated. Recently, a few reports have described promising results of hemiarthroplasty. This study describes the medium-term results of using the Kudo humeral implant (Biomet Ltd, Bridgend, U. K.) as replacement of the distal humerus. less thanbrgreater than less thanbrgreater thanMaterial and methods: Eight women (mean age, 79 years) were treated. Follow-up was conducted at a mean of 4 years after the procedure and consisted of the Mayo Elbow Performance Score (MEPS), radiographic images, and range of motion (ROM). less thanbrgreater than less thanbrgreater thanResults: All patients had a good or excellent outcome according to the MEPS. Mean ROM was 31 degrees to 126 degrees. Radiographic signs of attrition of the ulna were observed in 3 patients but did not correlate with the functional outcome. A periprosthetic fracture occurred in 1 patient 3 years after the index operation, and ROM was unsatisfactory in 1 patient. No other complications were observed. less thanbrgreater than less thanbrgreater thanConclusion: The use of the Kudo humeral implant as a hemiarthroplasty resulted in a reasonable functional outcome in the medium-term, but the radiographic signs of attrition suggest that the implant is not recommended as a hemiprosthesis.

Place, publisher, year, edition, pages
Elsevier, 2012
Keywords
Distal humeral fracture, osteoporosis, Kudo prosthesis, elderly women, elbow hemiarthroplasty, radiographic attrition
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-77538 (URN)10.1016/j.jse.2011.07.011 (DOI)000303148600007 ()
Available from: 2012-05-28 Created: 2012-05-22 Last updated: 2018-02-20
2. Hemiarthroplasty for irreparable distal humeral fractures: Medium-term follow-up of 42 patients
Open this publication in new window or tab >>Hemiarthroplasty for irreparable distal humeral fractures: Medium-term follow-up of 42 patients
2015 (English)In: The Bone & Joint Journal, ISSN 2049-4394, E-ISSN 2049-4408, Vol. 97B, no 10, p. 1377-1384Article in journal (Refereed) Published
Abstract [en]

We report our experience of performing an elbow hemiarthroplasty in the treatment of comminuted distal humeral fractures in the elderly patients. A cohort of 42 patients (three men and 39 women, mean age 72; 56 to 84) were reviewed at a mean of 34.3 months (24 to 61) after surgery. Functional outcome was measured with the Mayo Elbow Performance Score (MEPS) and range of movement. The disabilities of the arm, shoulder and hand questionnaire (DASH) was used as a patient rated evaluation. Complications and ulnar nerve function were recorded. Plain radiographs were obtained to assess prosthetic loosening, olecranon wear and heterotopic bone formation. The mean extension deficit was 23.5 degrees (0 degrees to 60 degrees) and mean flexion was 126.8 degrees (90 degrees to 145 degrees) giving a mean arc of 105.5 degrees (60 degrees to 145 degrees). The mean MEPS was 90 (50 to 100) and a mean DASH score of 20 (0 to 63). Four patients had additional surgery for limited range of movement and one for partial instability. One elbow was revised due to loosening, two patients had sensory ulnar nerve symptoms, and radiographic signs of mild olecranon wear was noted in five patients. Elbow hemiarthroplasty for comminuted intra-articular distal humeral fractures produces reliable medium-term results with functional outcome and complication rates, comparable with open reduction and internal fixation and total elbow arthroplasty.

Place, publisher, year, edition, pages
BRITISH EDITORIAL SOC BONE JOINT SURGERY, 2015
National Category
Clinical Medicine Orthopaedics
Identifiers
urn:nbn:se:liu:diva-122788 (URN)10.1302/0301-620X.97B10.35421 (DOI)000363600600013 ()26430013 (PubMedID)
Available from: 2015-11-23 Created: 2015-11-23 Last updated: 2018-02-20Bibliographically approved
3. A radial head prosthesis appears to be unnecessary in Mason-IV fracture dislocation
Open this publication in new window or tab >>A radial head prosthesis appears to be unnecessary in Mason-IV fracture dislocation
2017 (English)In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 88, no 3, p. 315-319Article in journal (Refereed) Published
Abstract [en]

Background and purpose - Previous reports on elbow injuries with concomitant comminute radial head fracture are difficult to interpret, since they include an array of different soft-tissue and bony injuries around the elbow. We focused on Mason-IV fracture dislocations of the elbow and retrospectively reviewed 2 treatment options: radial head resection or replacement with a radial head arthroplasty, both in combination with lateral ligament repair. Patients and methods - In Linkoping, 18 consecutive patients with Mason-IV fracture dislocation and with a median age of 56 (19-79) years were treated with a radial head arthroplasty. In Malmo, 14 consecutive patients with a median age of 50 (29-70) years were treated for the same injury with radial head resection. With a follow-up of at least 2 years (Linkoping: median 58 months; Malmo: median 108 months), the outcome was assessed using the Mayo elbow performance score (MEPS), the Disabilities of Arm, Shoulder, and Hand questionnaire (DASH), range of movement, instability, and plain radiographs. Results - There was no statistically significant difference between the groups regarding MEPS, DASH, or range of motion. The rate of additional surgery was higher in patients treated with arthroplasty. Ulno-humeral osteoarthritis was more pronounced in the group treated with radial head resection, but the follow-up time was longer in these patients. Functional results and range of motion tally well with previous reports on similar injuries. Interpretation - Functional results did not improve by using a press-fit radial head arthroplasty in Mason-IV fracture dislocation of the elbow. Secondary osteoarthritis after resection of the radial head is a concern, but it did not affect the functional outcome during the follow-up time.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2017
National Category
Orthopaedics
Identifiers
urn:nbn:se:liu:diva-137869 (URN)10.1080/17453674.2017.1293440 (DOI)000400742500014 ()28464753 (PubMedID)
Available from: 2017-06-02 Created: 2017-06-02 Last updated: 2018-05-02

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