Frankle (2003) — A comparison of open reduction and internal fixation and primary total elbow arthroplasty in the treatment of intraarticular distal humerus fractures in women older than age 65.

A Comparison of Open Reduction and Internal Fixation and Primary Total Elbow Arthroplasty in the Treatment of Intraarticular Distal Humerus Fractures in Women Older Than Age 65.

·J Orthop Trauma·2003·374 citations·Trauma

Retrospective cohort of 24 women >65 with OTA 13.C2/13.C3 distal humerus fractures comparing ORIF (n=12) vs. primary TEA (n=12), using the Mayo Elbow Performance score and need for revision surgery as primary outcomes at minimum 2-year follow-up.

Study Snapshot

Design

Retrospective cohort

Setting: Level 1 trauma + tertiary referral center, Tampa

Funding: None

Objective

Whether TEA yields better outcomes than ORIF for distal humerus fractures in elderly women

Outcome(s)

Mayo Elbow Performance Score and revision surgery rate

Subjects

24 women >65 years (ORIF n=12, TEA n=12)

12ORIF via AO/ASIF principles, olecranon osteotomy
12Primary semiconstrained cemented TEA, Conrad-Morrey implant

Inclusion

Women >65 years
Intraarticular distal humerus fracture (OTA 13.C2/C3)
Minimum 2-year follow-up

Exclusion

Open fractures
Neurovascular injury

Follow-up

Mean 57 months (range 24–78)

Key Findings

TEA produced 11 excellent / 1 good results (no fair or poor); ORIF produced 4 excellent, 4 good, 1 fair, and 3 poor — mean Mayo scores 95.0 vs. 87.7 in healed-without-revision ORIF patients
25% of ORIF cases failed (3/12) due to fixation failure and required conversion to TEA; 2 of those 3 needed a second revision for ulnar component loosening at 8 and 12 months
TEA required far less rehabilitation: fewer than 2 PT visits vs. ~30 visits over 3 months for ORIF, and tourniquet time was nearly half (78 vs. 146 min)
All 3 ORIF failures shared comorbidities of osteoporosis and systemic steroid use; 100% of the TEA group had osteoporosis and 67% had rheumatoid arthritis — a selection bias the authors openly acknowledge
Authors propose primary TEA for elderly women with comorbidities (osteoporosis, RA, systemic steroids); ORIF remains preferred in those with adequate bone stock and no significant comorbidities

Clinical Relevance

When you see a complex intraarticular distal humerus fracture (OTA 13.C2/C3) in a woman over 65 with osteoporosis, rheumatoid arthritis, or systemic steroid use, think primary TEA — this paper showed a 25% ORIF failure rate in exactly that population, while TEA yielded 11/12 excellent results with minimal rehabilitation burden.

In patients with good bone stock and no major comorbidities, experienced-surgeon ORIF remains a viable first choice.

Core

A Comparison of Open Reduction and Internal Fixation and Primary Total Elbow Arthroplasty in the Treatment of Intraarticular Distal Humerus Fractures in Women Older Than Age 65.

Frankle, Sanders, et al.·J Orthop Trauma·2003·374 citations·Trauma

A Comparison of Open Reduction and Internal Fixation and Primary Total Elbow Arthroplasty in the Treatment of Intraarticular Distal Humerus Fractures in Women Older Than Age 65.

Study Snapshot

Key Findings

Clinical Relevance

Related Articles

A Comparison of Open Reduction and Internal Fixation and Primary Total Elbow Arthroplasty in the Treatment of Intraarticular Distal Humerus Fractures in Women Older Than Age 65.

Study Snapshot

Key Findings

Clinical Relevance

Related Articles

A Comparison of Open Reduction and Internal Fixation and Primary Total Elbow Arthroplasty in the Treatment of Intraarticular Distal Humerus Fractures in Women Older Than Age 65.

Study Snapshot

Key Findings

Clinical Relevance

Related Articles

A Comparison of Open Reduction and Internal Fixation and Primary Total Elbow Arthroplasty in the Treatment of Intraarticular Distal Humerus Fractures in Women Older Than Age 65.

Study Snapshot

Key Findings

Clinical Relevance

Related Articles