Outcomes After Acute Versus Delayed Total Elbow Arthroplasty for the Treatment of Distal Humerus Fractures

Christina Liu; Dafang Zhang; Philip Blazar; Brandon E Earp

doi:10.1016/j.jhsg.2023.05.006

Outcomes After Acute Versus Delayed Total Elbow Arthroplasty for the Treatment of Distal Humerus Fractures

J Hand Surg Glob Online. 2023 Jun 4;5(5):612-619. doi: 10.1016/j.jhsg.2023.05.006. eCollection 2023 Sep.

Authors

Christina Liu^{1

2}, Dafang Zhang^{1

2}, Philip Blazar^{1

2}, Brandon E Earp^{1

2}

Affiliations

¹ Division of Hand and Upper-Extremity Surgery, Department of Orthopedics, Brigham and Women's Hospital, Boston.
² Harvard Medical School, Boston, MA.

Abstract

Purpose: Compare outcomes of acute versus delayed total elbow arthroplasty (TEA) following distal humerus fractures (DHF).

Methods: This retrospective study included 39 patients who underwent primary TEA with semiconstrained implants for DHF, either within 4 weeks of their injury or after failing initial open reduction and internal fixation (ORIF) or nonsurgical management, between June 1, 2003 and February 1, 2018 with minimum 1-year follow-up. Our outcome measures included QuickDASH (Disabilities of the Arm, Shoulder, and Hand) score, complications, reoperations, and range of motion (ROM). Demographics, clinical variables, and outcomes were compared using the Student's t-test, Mann-Whitney U test, and Fisher's exact test as appropriate. Kaplan-Meier curves for mortality, implant survivorship, and reoperation were created.

Results: Our patients were categorized into acute TEA (n = 22), ORIF to TEA (n = 10), and nonsurgical to TEA (n = 7) treatment groups. Additional analysis was performed comparing acute to delayed TEA, which combined data from failed ORIF and nonsurgical cohorts. The median follow-up, average age, and median Charlson comorbility index were similar between groups. The most common fracture pattern was AO13C. At median follow-up of 5.8 years, QuickDASH differed between cohorts: mean of 31 (SD 19) in acute TEA and 52 (SD 27) in delayed TEA, which further subdivided to 44.2 (SD 25) in failed ORIF and 76 (SD 23) in failed nonsurgical management. Poorer QuickDASH scores at final follow-up were associated with delayed TEA, initial nonsurgical management, and depression. Surgical complications were associated with delayed TEA. Higher Charlson comorbidity index was associated with death. No variables were associated significantly with ROM, revision, or reoperation.

Conclusion: Comminuted DHFs are difficult to treat in the elderly with high rates of complication and poor function after surgery. Our study suggests TEA performed acutely result in satisfactory outcomes and should be a consideration for patients at high risk of failing ORIF or nonsurgical management.

Type of study/level of evidence: Therapeutic, III.

Keywords: Distal humerus fracture; Elbow fracture; Malunion; Posttraumatic arthritis; Total elbow arthroplasty.