Elbow Fracture Clinical Trial
Total elbow arthroplasty (TEA) results in immediate pain release with good functional results after distal humerus fractures. But still open reduction and internal fixation is recommended as treatment of choise due to a lifelong loading limitiation, unknown implant survival and problematic revision surgery after TEA. The purpose of this study was to compare functional results and complication rates after primary total elbow arthroplasty (TEA) and TEA after failed reconstruction or non-operative treatment (secondary TEA) in the treatment of distal humerus fractures. We hypothesised that clinical and functional results are better for primary TEA with less complications.
Total elbow arthroplasty (TEA) results in immediate pain release with good functional results
after distal humerus fractures. But still open reduction and internal fixation is recommended
as treatment of choise due to a lifelong loading limitiation, unknown implant survival and
problematic revision surgery after TEA. The purpose of this study was to compare functional
results and complication rates after primary total elbow arthroplasty (TEA) and TEA after
failed reconstruction or non-operative treatment (secondary TEA) in the treatment of distal
humerus fractures.
This retrospective study was performed at a level I trauma centre. All patients were informed
about the study and provided written informed consent.
All patients undergoing total elbow arthroplasty (TEA) were identified by electronically
screening our database by the OPS codes 5-824.4 (implantation of a linked TEA) and 5-824.5
(implantation of an unlinked TEA) between August 2008 and May 2014. Based on patient records
and x-rays the indication for implantation of the TEA was retrospectively reviewed. All
patients, who received a TEA for an acute trauma with fracture of the distal humerus (primary
TEA) or due to a failed reconstruction or non-operative treatment after a distal humerus
fracture (secondary TEA), were included in this study. A minimum follow-up of 6 months was
set as inclusion criterion. Exclusion criteria were previous injury at the fractured elbow,
neuro-muscular disease, cortisone or other immune suppressive therapy and open fracture grade
II or higher according to Tscherne and Ostern.The patient records were reviewed for
demographic and perioperative data. If the initial treatment was not conducted in our
department, radiographs and patient records were requested. The follow-up examination
included the evaluation of the range of motion and stability of the elbow, actual pain and
satisfaction of the patient. To objectify the functional result the Mayo Elbow Performance
Score (MEPS) and Disabilities of the Arm, Shoulder and Hand Score (DASH) were determined.
Additionally, complications and revision surgeries were recorded. Complications were split up
into minor (nerve irritation or postoperative haematoma) and major complications, which
required a revision of the prosthesis. Periprosthetic fractures due to renewed fall with an
adequate trauma were not counted as complication.
Perioperative data, the functional result (range of motion, MEPS, DASH) and postoperative
complications were described for each group. Subsequently, these results were statistically
compared using the Mann-Whitney U test as a two-way analysis of variance for independent
factors. A p-value ≤ 0.05 was considered statistically significant. The statistical analysis
was performed using SPSS for MAC (IBM SPSS Statistics 22, Chicago, Illinois).
We hypothesised that clinical and functional results are better for primary TEA with less
complications.
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