Open reduction and internal fixation versus total elbow arthroplasty for distal humerus fractures in elderly patients: a mid-term retrospective study.

PURPOSE: There is still no consensus about treatment distal humerus fractures (DHF) in elderly patients. This retrospective study compare the mid-term outcomes of intraarticular DHF in patients over 60 years of age treated with open reduction and internal fixation (ORIF) and total elbow arthroplasty (TEA).

METHODS

We have evaluated 64 patients who have undergone treatment for intra-articular DHF (AO types C, 31 TEA vs. 33 ORIF). Our assessment included: range of motion, Mayo Elbow Performance Score (MEPS), Quick-DASH score and numeric pain score (NRS). Rate of complications and reoperations were examined. All patients were followed for a minimum of three years.

RESULTS

At the final follow-up, mean flexion-extension ROM was 119,9° +/-27.8° vs 79.3° +/-23.8° for TEA group and ORIF group respectively and prono-supination ROM was 167.8°+/-16.2° vs 150.2°+/-36.9°. Mean MEPS was 82.6+/-12.6 vs 70.3+/-13.6 for TEA and ORIF respectively. Mean DASH score was lower in the TEA group, 22.7+/-15.5 vs 37.6+/-21.2. The number and rate of complications was higher in the ORIF group. Reoperation rates were 30.3% and 19.35% for ORIF and TEA respectively.

CONCLUSIONS

TEA could lead to a satisfying functional outcomes with more predictable results and less complication then ORIF for DHF in the elderly.