78 - Freie Mitteilung
16. Mai 2019, 17:30 - 19:00, Sopra 3, 4. OG
Elbow hemiarthroplasty for selected distal humerus fractures in the elderly: A preliminary report
D. Rikli1, M. Schmelz2, A. M. Müller1, C. Schwaller2, S. Müller1, M. Jakob1, Presenter: D. Rikli1 (1Basel, 2Olten)
Primary Total Elbow Arthroplasty (TEA) is an option in the treatment of acute distal humerus fractures in the elderly. Results comparable to ORIF have been reported. However, loading of the upper extremity after TEA must be restricted which may limit activities of patients who use their upper limb as a walking aid. Hemiarthroplasty is an alternative in the fracture situation where the proximal forearm is not involved. If the elbow is stable (healed epicondyles), the extremity can be used without limitations.
Between 4/2017 and 7/2018 we have used Elbow Hemiarthroplasty (Latitude, Fa. Wright/Tornier) as a primary treatment in 6 consecutive elderly female patients (70-88y) with extremely low distal humerus fractures that seemed not to be amenable to ORIF . Routine radiological follow up was performed at 6 and 12 weeks and at latest follow up. Clinical outcome was documented with ROM, pain VAS, a Subjective Elbow Value (SEV), Quick-DASH, Oxford Elbow Score, and Mayo Elbow Performance Score. Suhm's scale was used to assess any change in self-dependency.
There were no implant related complications or infections. All epicondyles healed with a stable elbow except one with a slight medial opening that was asymptomatic. One patient who had a delayed initial operation (2 weeks post trauma) needed a revision operation (arthrolysis and removal of periarticular ossifications) 6 months after the index procedure due to stiffness. The remaining had a subjectively satisfactory result (SEV 80-100%), ROM >100° and good to excellent clinical scores ratings. 4/6 used a walking aid (Rollator), all returned to their premorbid social environment.
Elbow Hemiarthroplasty appears to be a valuable option in the treatment of difficult distal humerus fractures in the elderly. Compared to Total Elbow Arthroplasty restrictions in loading the extremity are not necessary which is an advantage for patients who use their upper limb for walking aids. Long term results are needed.