Open Reduction and Internal Fixation Versus Acute Arthroplasty for the Management of Common Extremity Injuries: Evidence-Based Decision Making.

A considerable burden of disease is associated with the management of periarticular fractures. Increasingly, evidence-based medicine is used to define the standard of clinical care. The role of internal fixation in the management of periarticular fractures, particularly in elderly patients, has been questioned. Currently available evidence-based medicine studies may help surgeons decide whether open reduction and internal fixation or arthroplasty is appropriate for the management of common periarticular injuries. The management of periarticular injuries about the shoulder, elbow, hip, and knee is controversial. The long-term outcomes of patients with a periarticular upper or lower extremity injury who undergo open reduction and internal fixation are limited by high complication and revision surgery rates and poor functional outcomes. Despite evidence-based medicine decision making and the substantial number of prospective clinical trials available in the literature, a lack of consensus with regard to best practices for the surgical management of periarticular injuries exists. This lack of consensus has substantial implications given that proximal humerus, elbow, hip, and knee fractures are common and that the role of acute arthroplasty in the management of periarticular injuries is changing.