| Purpose: We evaluated the elbow performance and curative effect of the total elbow replacement(TER),and compared with the patients with open reduction and internal fixation(ORIF).We study the function of treatment for the elderly distal humeral fracture with total elbow replacement.Methods: From Jul.2015 to Mar.2017,for elderly patients with distal humeral fractures that conformed to the criteria for and excluded the contraindications of the operations,we used the total elbow replacement(TER)and open reduction and internal fixation(ORIF).The inclusion criteria were:(1)the age>60;(2)the patients caused by the acute injury;(3)The operation was performed within 3 weeks after the injury;(4)The fracture was AO/OTA 13 C type(including C1,C2,C3);(5)Closed fracture and Gustilo type ? open fracture which was treated by debridement within 12 hours from the injury.We analyzed the preoperative and intraoperative data,and the patients were followed up at 6 weeks,3 months,6 months and 1 year.We used Mayo elbow performance score(MEPS)and Disabilities of the Arm,Shoulder and Hand(DASH)to evaluated the curative effect,and the X-ray to observe fracture healing and prosthesis failure and the complications.Results: The operation duration of total elbow replacement group was less than that of the fixation group(124.71±43.82 min and 169.53±62.72 min,p=0.022).The total hospitalization cost of total elbow replacement(TER)group was less than that of the fixation group(?48884.91±13768.52 and 69902.73±?14348.00,p=0).The DASH scores were significantly improved for TER compared with ORIF at 6 weeks(43.76±9.27 and 67.29±9.46,p=0.019)and 6 months(28.71±4.09 and 40.88±6.2,p=0.041).The postoperative MEPS for TER was improved compared with ORIF at 3 weeks(77.82±8.81 and 64.82±9.75,p=0.011),6 months(80.18±7.25 and 67.59±9.04,p=0.009)and 1 year(84.23±8.86 and 70.88±9.27,p=0.015).At the last follow-up,on the basis of the MEPS,in the TER group 10 cases were excellent,5 good,and 2 fair,and the excellent and good rate was 15/17,and in the ORIF group 2 cases were excellent,8 good,and 7 fair,and the excellent and good rate was 10/17.One-stage incision healing were achieved in all patients in the TER group.In the TER group,there were 3 patients with sensory deficit of ulnar nerve after surgery,and with the continuous observation,all patients achieved remission of the symptom.Superficial infection of incision wound was occurred in 2 patients.There were no prosthesis failure,bone resorption,and dislocation of elbow joint.In the ORIF group,deep infection was occurred in 1 patient,requiring 2-stage healing.There were 4 patients with sensory deficit of ulnar nerve after surgery and with the continuous observation,all patients achieved remission of the symptom.Heterotopic ossification occurred in 2 patients,and 1 patient underwent reoperation in 48 weeks,including removal of hardware and a capsular release,and another one didn't.Conclusion: For elderly patients with distal humeral fracture treated with total elbow replacement(TER),compared with open reduction and internal fixation(ORIF),they have better function,the hospitalization costs are lower,the operation duration is shorter.The total elbow replacement(TER)is one optimal selection for distal humeral intra-articular fracture in the elderly with the comminution and shift of the articular surface or severe osteoporosis. |
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