| 1. |
- Nestorson, Jens, 1969-, et al.
(författare)
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Arthroplasty as primary treatment for distal humeral fractures produces reliable results with regards to revisions and adverse events : a registry-based study
- 2019
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Ingår i: Journal of shoulder and elbow surgery. - Philadelphia, PA, United States : Mosby, Inc.. - 1058-2746 .- 1532-6500. ; 28:4, s. E104-E110
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPrimary prosthetic replacement has become an accepted method for the treatment of complex distal humeral fractures. The present study investigated implant survival and adverse events related to this procedure based on available Swedish registries and examined the completeness of the Swedish Elbow Arthroplasty register.Materials and methodsPatients treated in Sweden with a primary elbow replacement due to a distal humeral fracture between 1999 and 2014 were identified through 3 different registries: The Swedish Elbow Arthroplasty Register, National Board of Health and Welfare inpatient register, and local registries of all orthopedic departments. Prosthetic survival was examined using Cox regression analysis with Kaplan-Meier plots. Adverse events, defined as medical treatment of the affected elbow besides revision, were analyzed separately. The study included 406 elbows in 405 patients, and no register was complete.ResultsImplant survival at 10 years was 90% (95% confidence interval, 85%-96%), but only 45 patients had an observation time of 10 years or more because 46% of the patients had died, resulting in a mean observation time of 67 (standard deviation, 47) months. An increase in the use of hemiarthroplasties and a proportional decrease of total elbow arthroplasties was detected. There were 18 revisions (4%), and 26 patients (6%) experienced an adverse event, of whom 16 (4%) required surgery. The completeness of the Swedish Elbow Arthroplasty Register regarding primary arthroplasty was 81%.ConclusionPrimary arthroplasty as treatment of distal humeral fractures produces reliable results with regards to revisions and other adverse events.
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| 2. |
- Nestorson, Jens, 1969-
(författare)
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Arthroplasty in Elbow Fracture Treatment
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Open reduction and internal fixation is the treatment of choice for distal humeral fractures. Stable fixation is required to allow early mobilisation and to reduce the risk of poor functional results. In an elderly patient with osteoporotic bone and with a comminuted intra-articular fracture stable internal fixation can be difficult to achieve. In these cases elbow arthroplasty is an option.An irreparable radial head fracture can be treated by excision or replacement. The indications for the respective procedure are unclear since reports include an array of different associated soft-tissue and bony injuries.The aim of this thesis was to evaluate the use, complication rates and functional outcome of elbow arthroplasty as primary treatment for complex distal humeral fractures and assess the usefulness of radial head replacement in Mason IV fracture dislocations.50 patients, aged 56-89 years were treated for a distal humeral fracture with primary hemi-arthroplasty using the Kudo© humeral component or the Latitude® prosthesis. The functional outcome was assessed retrospectively. The majority of the 50 patients treated with a primary hemi-arthroplasty for a distal humeral fracture had a good or excellent functional result and regained a functional arc of movement of at least 100 degrees at medium term follow-up. There were six patients suffering secondary surgery and two with persistent ulnar nerve symptoms. Wear of the olecranon fossa was seen, mainly in the eight patients treated with a non-anatomical implant (Kudo®). Functional results were comparable to total elbow arthroplasty and open reduction and internal fixation (ORIF) for distal humeral fractures. The use of implants that are more anatomical seemed to reduce the degree of olecranon wear but long-term results are lacking.The nationwide use of primary arthroplasty for a distal humeral fracture between 1999 and 2014 was examined using three different registers. The survival rates in relation to prosthetic desing, age and sex were investigated using Cox regression analysis and number of adverse events recorded.In total 405 patients were treated with primary arthroplasty for a distal humeral fracture. The mean age at surgery was 75 years and the mean observation time was 67 months. Eighteen patients had undergone revision surgery and another 26 patients suffered an adverse event, 24 of which required secondary surgery.Increasing age reduced the risk for revision and there was no significant difference in survival between total- and hemi arthroplasty. The cumulative survival rate at 5 years was 99% (CI 98-100) and at 10 years 90% (CI 85-96). Elbow arthroplasty as primary treatment for distal humeral fractures produced reliable results with regards to revision surgery and adverse events.18 patients, age 19-79 years, treated with radial head replacement, and 14 patients, age 29-70 years, treated with radial head resection, for a Mason IV fracture dislocation were retrospectively reviewed.There were no significant differences in functional outcome in patients treated with replacement or excision for a Mason IV fracture dislocation. The rate of secondary surgery was higher in patients treated with replacement and ulno-humeral osteoarthritis was more pronounced in patients treated with radial head excision but follow-up was longer in these patients. Functional results were not improved by using radial head arthroplasty for Mason IV fracture dislocation. Secondary osteoarthritis is a concern in patients treated with excision but did not affect functional outcome after a mean follow-up time of 108 months.
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| 3. |
- Svernlöv, Birgitta, et al.
(författare)
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Subjective ulnar nerve dysfunction commonly following open reduction, internal fixation (ORIF) of distal humeral fractures and in situ decompression of the ulnar nerve
- 2017
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Ingår i: Strategies in trauma and limb reconstruction (Online). - : Springer. - 1828-8928 .- 1828-8936. ; 12:1, s. 19-25
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this retrospective study was to investigate the frequency of persistent ulnar affection in patients who underwent open reduction and internal fixation (ORIF) of distal humeral fractures without ulnar nerve transposition or mobilisation. Eighty-two patients (53 women), mean age 62 years, were, at a mean of 48 months, reviewed through medical records and a subjective evaluation form concerning ulnar nerve problems. Ulnar nerve affliction, in most cases regarded as mild, was experienced by 22 patients (27%; 14 women) and significantly associated with multiple surgeries. Three patients had been operated with late neurolysis and one with transposition without reported improvement. The proportion of ulnar nerve dysfunction was equally common regardless of medial or lateral plating. ORIF with plate fixation and without ulnar nerve transposition seems to be an acceptable option for patients with distal humeral fractures. The frequency of ulnar nerve affection in our series does not appear higher than previously reported. Subjective ulnar nerve symptoms were, however, relatively common and appear related to the trauma itself, the surgery, or the post-operative management which highlights the need for further analysis of these factors.
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