Outcomes of total elbow arthroplasty in the treatment of distal humeral fractures in the elderly: A retrospective cohort comparison between primary arthroplasty and arthroplasty secondary to failed internal fixation

Stefano Palladino; Florent Baldairon; Julien Godet; Philippe Clavert

doi:10.1016/j.jse.2024.03.032

Outcomes of total elbow arthroplasty in the treatment of distal humeral fractures in the elderly: A retrospective cohort comparison between primary arthroplasty and arthroplasty secondary to failed internal fixation

J Shoulder Elbow Surg. 2024 May 4:S1058-2746(24)00314-8. doi: 10.1016/j.jse.2024.03.032. Online ahead of print.

Authors

Stefano Palladino¹, Florent Baldairon², Julien Godet³, Philippe Clavert²

Affiliations

¹ Upper Limb Surgery Department, Hôpital de Hautepierre 2, Strasbourg University Hospital, Strasbourg, France. Electronic address: stefano.palladino88@gmail.com.
² Upper Limb Surgery Department, Hôpital de Hautepierre 2, Strasbourg University Hospital, Strasbourg, France.
³ Public Health department, Strasbourg University Hospital, Strasbourg, France.

PMID: 38710364
DOI: 10.1016/j.jse.2024.03.032

Abstract

Background: The primary objective of this study was to compare the clinical outcomes of total elbow arthroplasty as the index procedure in the treatment of traumatic distal humerus fractures, with secondary total elbow arthroplasty following failed internal fixation. The secondary objectives were to compare the complication rates and the radiographic results in the two groups. Our hypothesis was that the clinical results of total elbow arthroplasty performed secondarily to failed internal fixation were comparable to primary total elbow arthroplasty in the treatment of distal humerus fractures in the elderly population.

Methods: We conducted a retrospective cohort comparison study, including 60 patients with a median age of 80 years (71-85), who either underwent a primary total elbow arthroplasty (group 1; 45 patients), or secondary total elbow arthroplasty following failed internal fixation (group 2; 15 patients), in the treatment of a post-traumatic supra and intercondylar fracture of the distal humerus, between January 2004 and January 2021. The clinical examination, including MEPS score and triceps proficiency test, complication rates and the need for re-operation were noted. The average clinical and radiographic follow-up was 40.8 months (24-120).

Results: The clinical results of the two groups were comparable when looking at the MEPS score (90.00 [85.00, 100.00] p= 0.486). With regards to complications, there were 2 surgical site infections in group 1 and 3 in group 2 (p=0.099), 1 case of mechanical loosening of the humeral component in group 1 and 1 in group 2 (p= 0.448), and 1 patient with triceps insufficiency in group 1.

Conclusion: Secondary total elbow arthroplasty following failed internal fixation has shown good functional results, and a complication rate comparable to that of index total elbow arthroplasty in the treatment of articular fractures of the distal humerus in the elderly.

Keywords: MEPS; Total elbow arthroplasty; complications; fracture; traumatology.