Total elbow arthroplasty for non-rheumatoid patients with a fracture of the distal humerus

Prasad, N.; Ali, Amjid; Stanley, David

doi:10.1302/0301-620x.98b3.35508

Cited by 63 publications

(36 citation statements)

References 20 publications

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“…The long-term survival rate of elbow arthroplasty is still lower than that for hip or knee arthroplasty,[ 12 ] and almost half of the patients need revision surgery within 10 years. [ 13 ] Bone defects are a critical problem in arthroplasty because both humerus and ulna are smaller than the femur and tibia. Furthermore, less bone storage exists in the ulna, thus making it more difficult to stabilize the prosthesis during revision surgery.…”

Section: Discussionmentioning

confidence: 99%

Inserting the Ulnar Prosthesis into Radius as a Novel Salvage Surgery for Revision Total Elbow Arthroplasty with Massive Bone Defect

Gong

Jiang

et al. 2016

Chinese Medical Journal

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Background:Infection and aseptic loosening are common complications of total elbow arthroplasty (TEA) and often require revision surgery. However, bone defects, along with other complications, bring an extra difficulty to the second surgery, especially for patients with a massive bone defect in the proximal ulna. Several methods including allograft or autograft have been introduced into practice, but none sufficiently solves these problems.Methods:We conducted a new surgical method for patients with a massive ulnar bone defect needing revision TEA. During revision arthroplasty, the ulnar prosthesis was inserted into the radius as a salvage procedure. Four consecutive patients received revision arthroplasty with this method between 2013 and 2016. Patients’ data were collected to evaluate the clinical outcome.Results:All patients had a Grade III ulnar bone defect. At the last follow-up session, all patients reported a painless, functional elbow joint. Three patients suffered from a periprosthetic infection that was completely cured using the two-stage method. No major complications, including infection, aseptic loosening, or wound problems were found. One patient had a transient ulnar neuritis, and another had a transient radial neuritis. Both patients had full recovery at the last follow-up session.Conclusions:Inserting an ulnar prosthesis into the radius is a novel procedure for patients with a massive bone defect due to infection or aseptic loosening. It is a safe, quick, and effective treatment with a promising short-term outcome. This method should be provided as a salvage procedure for patients with a nonreconstructable ulnar bone defect.

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Section: Discussionmentioning

confidence: 99%

Inserting the Ulnar Prosthesis into Radius as a Novel Salvage Surgery for Revision Total Elbow Arthroplasty with Massive Bone Defect

Gong

Jiang

et al. 2016

Chinese Medical Journal

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“…Recent studies of total elbow arthroplasty for acute distal humeral fractures with mean follow-up of at least 2 years are summarized in Table 1. 19,21,42,60,[67][68][69][70][71][72][73][74][75][76][77] Surgical interventions for intra-articular fractures aim to restore painless, functional range of motion. A functional flexion-extension arc of motion for the elbow has traditionally been defined as 100° (range, 30°-130°), and the average arcs reported in the studies the authors reviewed ranged from 85° to 122.5°.…”

Section: Total Elbow Arthroplastymentioning

confidence: 99%

“…In their systematic review, Voloshin et al 25 reported a 21.5%±9.2% overall complication rate with total elbow arthroplasty for acute distal humeral fractures, consistent with findings of the studies the current authors reviewed. 19,21,42,60,[67][68][69][70][71][72][73][74][75][76] Common complications include ulnar nerve dysfunction, triceps weakness or rupture, wound issues, infection, and aseptic loosening or mechanical complications.…”

Section: Total Elbow Arthroplastymentioning

confidence: 99%

“…In the studies listed in Table 1, the rates of reoperation for ulnar neuropathy ranged from 0% to 13%, and no reoperations were required in the studies in which only decompression without transposition was performed. 42,69,71 Routine anterior transposition of the ulnar nerve may increase the risk of reoperation for postoperative ulnar nerve dysfunction, although this is debatable with the available literature.…”

Section: Total Elbow Arthroplastymentioning

confidence: 99%

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Distal Humeral Hemiarthroplasty Versus Total Elbow Arthroplasty for Acute Distal Humeral Fractures

Rangarajan¹,

Papandrea²,

Çil³

2017

Orthopedics

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For acute distal humeral fractures not amenable to open reduction and internal fixation, total elbow arthroplasty has become an established alternative. However, lifelong activity restrictions designed to prevent early mechanical failure make this a poor option for some patients. This has led to a renewed interest in distal humeral hemiarthroplasty. Using modern implants and techniques, distal humeral hemiarthroplasty has shown outcomes comparable to those of total elbow arthroplasty at short- to mid-term follow-up, with an overall higher but different complication rate. Long-term data are needed, but the available literature suggests that distal humeral hemiarthroplasty be considered as another option on the treatment spectrum in select patient populations. [Orthopedics. 2017; 40(1):13-23.].

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“…Prasad et al . [ 42 ] analysed the survival of TEA in fracture patients and showed that only 53% had implant survival of more than 10 years and 89.5% of patients demonstrated loosening of their prostheses at this stage.…”

Section: Elbow Arthroplastymentioning

confidence: 99%

Distal Humeral Fractures-Current Concepts

Beazley¹,

Baraza²,

Jordan³

et al. 2017

TOORTHJ

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Background:Distal humerus fractures constitute 2% of all fractures in the adult population. Although historically, these injuries have been treated non-operatively, advances in implant design and surgical technique have led to improved outcomes following operative fixation.Methods:A literature search was performed and the authors’ personal experiences are reported.Results:This review has discussed the anatomy, classifications, treatment options and surgical techniques in relation to the management of distal humeral fractures. In addition, we have discussed controversial areas including the choice of surgical approach, plate orientation, transposition of the ulnar nerve and the role of elbow arthroplasty.Conclusion:Distal humeral fractures are complex injuries that require a careful planned approach, when considering surgical fixation, to restore anatomy and achieve good functional outcomes.

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Total elbow arthroplasty for non-rheumatoid patients with a fracture of the distal humerus

Abstract: The surgeons undertaking these procedures should be aware of the long-term revision rates and also the gender difference in the rates of loosening.

Cited by 63 publications

References 20 publications

Inserting the Ulnar Prosthesis into Radius as a Novel Salvage Surgery for Revision Total Elbow Arthroplasty with Massive Bone Defect

Inserting the Ulnar Prosthesis into Radius as a Novel Salvage Surgery for Revision Total Elbow Arthroplasty with Massive Bone Defect

Distal Humeral Hemiarthroplasty Versus Total Elbow Arthroplasty for Acute Distal Humeral Fractures

Distal Humeral Fractures-Current Concepts

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