Total elbow arthroplasty for distal humerus fractures provided similar outcomes when performed as a primary procedure or after failed internal fixation by Dr Bipul Borthakur

1. TOTAL ELBOW ARTHROPLASTY FOR
DISTAL HUMERUS FRACTURES PROVIDED
SIMILAR OUTCOMES WHEN PERFORMED
AS A PRIMARY PROCEDURE OR AFTER
FAILED INTERNAL FIXATION
DR BIPUL BORTHAKUR
PROFESSOR & HOD,
DEPT OF ORTHOPAEDICS, SMCH

2. INTRODUCTION
• Purpose of this study was to compare the outcomes of TEA
performed as the primary procedure for distal humerus fracture
with the outcomes of TEA performed in elbows after previous
internal fixation.
• Osteosynthesis is considered the gold standard for simple
fracture patterns and fractures in young patients , the relative
indications of internal fixation and elbow arthroplasty are less
clear in elderly.

3. PATIENTS AND METHODS
• Study was designed to compare patients treated acutely with TEA for DHF and those
who received TEA after osteosynthesis, hereafter referred to as the “salvage TEA’’.
• Study included 22 elbows treated acutely with TEA for DHF and 66 elbows that
underwent salvage TEA.
• The average follow-up times were 4.4 years for the acute group and 5.5 years for the
salvage TEA group.

4. PATIENTS AND METHODS
• Primary indication for salvage TEA-
• Non-union
• Post-traumatic osteoarthritis
• Hardware failure
• Instability
• Malunion

5. PATIENTS AND METHODS
• Methods for Triceps mobilization-
• Triceps on
• Triceps reflecting
• Triceps splitting
• Triceps tongue
• Olecranon osteotomy
• Triceps off

6. • 46 yr old woman who presented with painful medial distal himerus nonunion A) 13 months
after open reduction internal fixation. CT scan confirmed an ununited trochlea and capitellum
. The patient underwent salvage TEA B)

7. COONRAD MORREY TOTAL ELBOW
ARTHROPLASTY

8. COONRAD MORREY TOTAL ELBOW
ARTHROPLASTY

9. RESULTS
• Clinical outcomes were similar when comparing acute and salvage TEA groups
• There was no statistically significant difference in mean MEPS ( Mayo Elbow
Performance Scores), ulno humeral motion, flexion, flexion contracture, pronation and
supination.

10. RESULTS
• To determine whether patients 65 years of age and older at time ORIF may have
benefited if they had initially undergone acute TEA for their index feacture , our pateints
was stratified into patients of this age category at time of initial ORIF who ultimately
underwent salvage TEA and were then compared with those who were 65 years of age
and older at time of acute TEA. There was no significant difference noted.

11. POSTOPERATIVE COMPLICATIONS
• Heterotopic ossification
• Periprosthetic fracture
• Aseptic loosening
• Mechanical failure
• Deep surgical site infections
• Triceps failure
• Ulnar nerve symptoms
• Wound complications

12. POSTOPERATIVE COMPLICATIONS
• 42 % of all elbows in this study had at least one postoperative complication.
• The most commonly observed complication was aseptic loosening followed by deep
infection.

13. REOPERATIONS
• In this study 34 0f 88 patients (40%) had atleast one reoperation.
• There was no difference between acute and salvage TEA groups
• Time to reoperation was a mean of 23 months in the acute TEA group compared with
30.6 months in the salvage TEA group.

14. DISCUSSIONS
• TEA for DHF has become an acceptable and increasingly more common alternative to
ORIF.
• Elbow arthroplasty is commonly recommended for the salvage of complications of open
reduction and internal fixation.
• TEA is also considered for elderly patients with acute complex DHF, comminution, and
severe osteopenia.

15. DISCUSSION
• The use of TEA for acute DHF has been on the rise because –
• Satisfactory short term outcomes
• Greater familiarity with implants
• Shorter operative time
• Technically less demanding

16. DISCUSSION
• This study found comparable outcomes , complications, and reoperation rates between
patients who underwent TEA form acute DHF with those who underwent TEA as a
salvage operation after ORIF.

17. THANK YOU