Session IX - Upper Extremity


Sat., 10/20/07 Upper Extremity, Paper #57, 11:01 am OTA-2007

Distal Humerus Fractures (OTA 13C) in the Osteoporotic Elbow: Plate Fixation versus Total Elbow Arthroplasty

Kenneth A. Egol, MD (a-Synthes, Stryker, Biomet, Smith+Nephew);
Peter Tsai, MD (n); Nirmal C. Tejwani, MD (e-Zimmer, Biomet);
NYU Hospital for Joint Diseases, New York, New York, USA

Purpose: Intra-articular fractures about the osteoporotic distal humerus pose a significant challenge to the treating physician. The purpose of this study is to evaluate functional out­comes for distal humeral fractures in a nonarthritic elderly population treated with open reducation and internal fixation (ORIF) or total elbow arthroplasty (TEA).

Methods: The records of all female patients over 60 years of age who were treated for intra-articular distal humerus fractures (OTA 13C) treated by 2 surgeons were reviewed. Demographic and operative data were obtained. Charts were reviewed and patients con­tacted for functional data (DASH). 22 patients with 22 elbows were identified. One was excluded secondary to history of rheumatoid arthritis treated with chronic steroids, and another was excluded because of loss of fixation resulting in arthroplasty within 2 weeks of initial treatment. There were 9 patients who underwent cemented, semiconstrained TEA (Coonrad-Morrey, Zimmer, Warsaw, IN) as initial treatment of their fracture. These 9 patients were then compared to 11 patients who were treated with ORIF.

Results: The overall mean length of follow-up was 14.8 months (range, 6-38 months). There were no significant differences between the arthroplasty and the fixation groups with respect to demographic factors. Final range of elbow motion was 119° arc in the fixation group compared to 109° arc in the arthroplasty group. Two patients in the arthroplasty group died, and one in the fixation group could not be contacted for DASH. The mean DASH for the remaining patients was 85 for the fixation cohort and 89 for the arthroplasty group. These differences were not significant.

Radiographically, 10 of 11 fractures in the fixation group healed. The one nonunion with collapse is currently asymptomatic. Four TEAs developed radiographic loosening by a mean 15 months, one of which underwent revision with good outcome. Significant heterotopic bone developed in one patient who underwent TEA that limited her motion to a 50° arc of motion. Four patients in the fixation group underwent contracture release following union for limited range of elbow motion.

Conclusion: Many factors come into play when treating osteoporotic patients who sustain intra-articular distal humerus fractures. Implant selection must be based on bone quality and surgeon experience. Good results may be obtained with either TEA or ORIF when treating these injuries.


If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing.