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Elbow arthroplasty in trauma-current concepts review
A Stone1, G Chan2, L Sinclair3
1Shoulder & Elbow Post-CCT Fellow, University Hospitals Sussex NHS Foundation Trust, UK.
Journal of Orthopaedics
|December 6, 2022
Summary
Total elbow arthroplasty (TEA) and distal humeral hemiarthroplasty (DHH) offer valuable treatment options for elderly patients with complex distal humerus fractures. Careful surgical technique is crucial to minimize complications and achieve favorable outcomes.
Area of Science:
- Orthopedic Surgery
- Traumatology
- Biomaterials Science
Background:
- Distal humerus fractures in the elderly, particularly those with osteoporotic bone and comminuted articular fragments, present significant fixation challenges.
- Traditional fixation methods may yield unreliable results, hindering early motion and functional recovery in this patient population.
- Total Elbow Arthroplasty (TEA) and Distal Humeral Hemiarthroplasty (DHH) are emerging as viable alternatives for managing these complex fractures.
Purpose of the Study:
- To review the application of TEA and DHH for acute distal humerus fractures in elderly patients.
- To outline critical aspects of patient selection, pre-operative planning, surgical technique, and post-operative management.
- To discuss the outcomes, potential complications, and necessary considerations for arthroplasty in this specific fracture cohort.
Main Methods:
- Review of current literature and clinical practices regarding TEA and DHH for acute distal humerus fractures.
- Emphasis on patient selection criteria, pre-operative planning strategies, and surgical approaches.
- Detailed description of implant positioning techniques and methods for ensuring stable epicondyle repair in DHH and unlinked TEA.
Main Results:
- Arthroplasty offers an alternative when fixation is unreliable, but introduces unique potential complications.
- Meticulous attention to implant rotation, length, and sizing is essential for successful outcomes.
- Published outcomes for DHH and TEA in acute distal humerus fractures are encouraging, though further long-term comparative data is needed.
Conclusions:
- Both DHH and TEA are effective treatment modalities for carefully selected elderly patients with acute distal humerus fractures.
- Adherence to precise surgical techniques is paramount to mitigate risks and optimize functional results.
- Continued research focusing on long-term outcomes and comparative analyses of arthroplasty versus fixation is warranted.
