Total elbow arthroplasty in elderly trauma patients: adding a new perspective for functional evaluation
Nils Mühlenfeld1, Ingo Marzi2, Johannes Frank2
1Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany. nils.muehlenfeld@kgu.de.
Summary
Total elbow arthroplasty (TEA) in elderly trauma patients demonstrates good functional and dexterity outcomes. Purdue Pegboard skill tests offer a valuable objective measure for assessing post-surgery results in this population.
Area of Science:
- Orthopedic Surgery
- Trauma Surgery
- Geriatric Orthopedics
Background:
- Total elbow arthroplasty (TEA) is increasingly utilized for complex elbow conditions, including post-traumatic arthritis and unreconstructable fractures.
- Traditional outcome measures for TEA include range of motion (ROM), complication rates, and patient-reported scales (e.g., MEPS, DASH).
- Objective functional assessment beyond ROM is crucial for evaluating outcomes in elderly trauma patients undergoing TEA.
Purpose of the Study:
- To evaluate the functional outcomes of TEA in elderly patients (age > 60) who sustained elbow trauma.
- To introduce and assess the utility of Purdue Pegboard skill tests as an objective measure of dexterity and function after TEA.
- To compare functional outcomes between the operated and non-operated arm in this patient cohort.
Main Methods:
- Retrospective review of consecutive patients over 60 who underwent TEA for trauma.
- Inclusion of data from standardized follow-up examinations within 2 years post-TEA.
- Evaluation of Mayo Elbow Performance Score (MEPS), Disability of Arm, Shoulder and Hand (DASH) questionnaire, ROM, and Purdue Pegboard test scores.
Main Results:
- The study included elderly patients (mean age 76.0 years) with indications for TEA including post-traumatic arthrosis (68.8%) and unreconstructable fractures (31.3%).
- Mean MEPS was 82.81, mean DASH was 29.18, and mean ROM was 109.7°.
- Patients showed good, though marginally reduced, Purdue Pegboard scores compared to a healthy population, with no significant difference between the operated and non-operated arm after 2 years (p=0.715).
Conclusions:
- Total elbow arthroplasty is a viable alternative for elderly patients with complex elbow fractures, potentially avoiding revision surgery.
- TEA can serve as a secondary procedure for post-traumatic arthrosis following failed reconstructions.
- Satisfactory functional and dexterity outcomes are achievable with TEA, and skill tests like the Purdue Pegboard provide valuable objective assessment data.
