Background Distal humeral hemiarthroplasty has been performed for a variety of indications with the most common being management of distal humeral fractures. This systematic review evaluates the outcomes and complications of distal humeral hemiarthroplasty for this pathology. Methods We searched PubMed, EMBASE, and MEDLINE for studies reporting indications and outcomes of patients undergoing distal humeral hemiarthroplasty. Study screening, risk of bias assessment, and data extraction were performed. Summery statistics were provided. Results We included 11 studies ( N = 163) in this review. In all studies, the indication for distal humeral hemiarthroplasty was the presence of an intraarticular, comminuted, unreconstructable fracture. The mean post-operative MEPS, FullDASH, and QuickDASH (SD) scores were 83.6 (6.1) points, 25.4 (10.3), and 15.7 (7.4) points, respectively. The mean post-operative range of motion (SD) was 106° (11°) in the flexion and extension arc and 153° (19°) in the protonation and supination arc. The overall rate of adverse events and complication was 63%. The rate for major complications was 11%. The mean total revision rate was 4% (0% to 15) and total re-operation rate was 29% (0% to 88%). Conclusion Distal humeral hemiarthroplasty is a suitable option for unreconstructable distal humeral fractures and offers good functional outcomes with acceptable complication rates.
There is an age‐associated loss of phrenic motor neurons (PhMNs) and withdrawal of pre‐synaptic terminals at neuromuscular junctions (NMJs) in 24‐month old Fischer 344 (F344) rats. Previously, we showed that age‐related PhMN loss is concomitant with neuromuscular transmission failure and diaphragm muscle (DIAm) sarcopenia (an age‐related atrophy of muscle fibers and a decrease in specific force). It is unknown if pre‐synaptic terminal withdrawal precedes PhMN loss, which would implicate a reduction in a trophic influence emanating from muscle fibers (myogenic). We hypothesized that age‐related PhMN loss results from pre‐synaptic terminal withdrawal and reduced myogenic influence, which occurs predominantly at type IIx and/or IIb DIAm fibers (innervated by larger PhMNs). F344 rats were obtained from the National Institutes of Aging. Experimental ages were chosen to represent 100% and 50% survival at 6 months and 24 months‐old, respectively. PhMNs were first retrogradely labeled by intrapleural injection of cholera toxin‐subunit B (CTB), which is dependent on binding to pre‐synaptic terminal gangliosides. Thus, with pre‐synaptic terminal withdrawal, PhMNs would not be labeled. Subsequently (3 days after CTB), PhMNs were retrogradely labeled by sectioning the phrenic nerve and dipping the proximal end into a Rhodamine dextran (Rho) solution – this labeling is not dependent on pre‐synaptic terminals. CTB and Rho labeled PhMNs were visualized by confocal microscopy. Only optical slices containing the nucleus of Rho‐ and/or CTB‐labeled PhMNs were counted. We analyzed the differences in labeling of PhMNs by CTB and Rho in both age groups. In labeled PhMNs, short and long axis measurements were used to determine somal surface areas by assuming a prolate spheroid shape. In 6‐month old rats, there was no significant difference in the number of PhMNs labeled by CTB or Rho. In 24‐month old rats, the total number of labeled PhMNs was reduced compared to the 6‐month old rats, which primarily affected larger PhMNs. Furthermore, at 24‐months, fewer PhMNs were labeled with CTB compared to Rho and those labeled with Rho had larger somal surface areas. These results support our hypothesis that the age‐related loss of larger PhMNs results from pre‐synaptic terminal withdrawal and reduced myogenic influence. Support or Funding Information Support: NIH R01‐AG044615American Physiological Society
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