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Master Thesis

Evaluation des résultats à moyen terme des prothèses totales de coude dans les fractures de l’extrémité distale de l’humérus : traitement en aigu versus secondaire, série rétrospective de 28 cas

Abstract : Background - Total elbow arthroplasty (TEA) is now a reliable alternative acute treatment for complex distal humerus fractures (DHF), especially in the elderly patient. Complications can be treated by secondary TEA. The aim of our study was to compare functional, clinical and radiological outcomes and complication rate between acute TEA (primary TEA) and after post-traumatic sequelae following open reduction and internal fixation (ORIF) (secondary TEA) in DHF. We hypothesized that better results and less complications would be obtained with primary TEA.
Materiel and methods - Twenty-eight patients (mean age 70 years (41 – 90)) treated by TEA after DHF, with a 2 year minimum follow-up were included in this monocentric retrospective study from 2004 to 2018. TEA for non traumatic indications were excluded. Twelve primary TEA with a mean age of 81,1 years (70 – 90) were performed in acute procedure. Sixteen secondary TEA with a mean age of 62,2 years (41 – 77) followed from post-traumatic sequelae after ORIF. We made clinical, functional and radiological evaluations for the two groups. Clinical evaluation criterias were based on active range of motion, VAS, motor testing of biceps and triceps and difference of prehension strength with controlateral side. Functional evaluation criterias used the Mayo Elbow Performance Score (MEPS) as primary outcome, and the Quick-Dash and Katz scores. Radiological evaluation criterias included implant loosening, heterotopic ossifications and peri-prosthetic fractures.
Results - Results were evaluated at a mean follow-up of 53 months (21 – 143). Functional and clinical outcomes were better in primary TEA : MEPS 82 vs 71, p=0,032*; motor strength of biceps 5 vs 4,75, p=0,041* and triceps 5 vs 4, p=0,002*; difference of prehension strength 0,49 vs 6,6 kg, p=0,019*. One patient in the primary group presented a complication versus 11 patients in the secondary group (8,3% vs 65,7%, p=0,002*). Four patients in the secondary group had a prosthetic revision (0 vs 4, p=0,11) after aseptic loosening (n=2), infection and hinge mechanical failure.
Conclusion - Primary TEA in DHF treatment have better clinical and functional outcomes and a lower complication rate compared to secondary TEA. Secondary TEA should be considered as the final salvage option after failed ORIF.
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Master Thesis
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Submitted on : Tuesday, November 9, 2021 - 12:31:28 PM
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  • HAL Id : dumas-03420679, version 1

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Manon Colas. Evaluation des résultats à moyen terme des prothèses totales de coude dans les fractures de l’extrémité distale de l’humérus : traitement en aigu versus secondaire, série rétrospective de 28 cas. Médecine humaine et pathologie. 2020. ⟨dumas-03420679⟩

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