Abstract
Amaç: Bu çalışmada, distal humerus kaynamamalarının tedavisinde Coonrad-Morrey total dirsek protezinin orta dönem fonksiyonel ve radyolojik sonuçlarının değerlendirilmesi amaçlandı.Çalışma planı: Distal humerus kaynamama nedeniyle 7 hastaya Coonrad-Morrey total dirsek artroplastisi uygulanmıştır. Tamamı kadın olan n hastaların ortalama yaşı 65.6 idi. Ortalama takip süresi 73 ay iken minimum takip süresi 5 yıl olarak tespit edilmiştir. Ameliyat öncesi, hemen sonrası ve son kontrolde elde edilen dirsek anteriorposterior ve lateral grafileri ile radyolojik değişiklikler ve gevşeme değerlendirilirken, Mayo Elbow Performance Index (MEPI) ve Q-Dash skorları fonksiyonel değerlendirmede kullanılmıştır.Bulgular: Son kontrolde, 7 hastada da dirsek stabilitesinin sağlandığı görüldü. 6 hastanın(%87.5) ağrısı yoktu. Ameliyat öncesi 30° olan ortalama hareket açıklığının , son kontrolde ortalama 90.7° ye arttığı tespit edildi (p<0.05). MEPI (Mayo Elbow Performance Index) değerlendirmesinde 5 hastada (%71.4) mükemmel ve iyi sonuç elde edildği görüldü. Ortalama Q-Dash skoru 93.2 den 34.5 e gerilediği belirlendi (p<0.01). İki humeral komponent gevşemesi tespit edilirken biri revize edildi. Çıkarımlar: Distal humerus kaynamamalarında, semiconstrained (yarı kısıtlı) total dirsek artroplastisi internal fiksasyon teknikleri başarısız olduğunda güvenilir bir redavi yöntemi olabilir. Distal humerus kaynamama nedeniyle tedavi edilen hastalarda, semiconstrained (yarı kısıtlı) total dirsek artroplastisi ile stabil, ağrısız ve fonksiyonel bir dirsek elde edilebilmektedir
References
- Helfet DL, Kloen P, Anand N, Rosen HS. Open reduction and internal fixation of delayed unions and nonunions of fractures of the distal part of the humerus. J Bone Joint Surg Am 2003;85-A:33–40.
- Jupiter JB. The management of nonunion and malunion of the distal humerus-a 30-year experience. J Orthop Trauma 2008;22:742–50.
- 3 Morrey BF. Fractures of the distal humerus: role of elbow replacement. Orthop Clin North Am 2000;31:145–54.
- Choo A, Ramsey ML. Total elbow arthroplasty: current options. J Am Acad Orthop Surg 2013;21:427–37.
- Park SE, Kim JY, Cho SW, Rhee SK, Kwon SY. Compli- cations and revision rate compared by type of total elbow arthroplasty. J Shoulder Elbow Surg 2013;22:1121–7.
- Morrey BF, Bryan RS, Dobyns JH, Linscheid RL. Total elbow arthroplasty. A five-year experience at the Mayo Clinic. J Bone Joint Surg Am 1981;63:1050–63.
- Cil A, Veillette CJ, Sanchez-Sotelo J, Morrey BF. Linked elbow replacement: a salvage procedure for distal humeral nonunion. J Bone Joint Surg Am 2008;90:1939–50.
- Mitsunaga MM, Bryan RS, Linscheid RL. Condylar non- unions of the elbow. J Trauma 1982;22:787–91.
- Morrey BF, Adams RA. Semiconstrained elbow replace- ment for distal humeral nonunion. J Bone Joint Surg Br 1995;77:67–72.
- Lee BP, Adams RA, Morrey BF. Polyethylene wear af- ter total elbow arthroplasty. J Bone Joint Surg Am 2005;87:1080–7.
- McKee MD, Veillette CJ, Hall JA, Schemitsch EH, Wild LM, McCormack R, et al. A multicenter, prospective, randomized, controlled trial of open reduction-internal fixation versus total elbow arthroplasty for displaced in- tra-articular distal humeral fractures in elderly patients. J Shoulder Elbow Surg 2009;18:3–12.
- Espiga X, Antuña SA, Ferreres A. Linked total elbow ar- throplasty as treatment of distal humerus nonunions in pa- tients older than 70 years. Acta Orthop Belg 2011;77:304– 10.
- LaPorte DM, Murphy MS, Moore JR. Distal humerus nonunion after failed internal fixation: reconstruction with total elbow arthroplasty. Am J Orthop (Belle Mead NJ) 2008;37:531–4.
- Ali A, Shahane S, Stanley D. Total elbow arthroplasty for distal humeral fractures: indications, surgical approach, technical tips, and outcome. J Shoulder Elbow Surg 2010;19(2 Suppl):53–8.
Is Coonrad-Morrey total elbow arthroplasty a viable option for treatment of distal humeral nonunions in the elderly?
Abstract
Objective: The purpose of this study was to evaluate the functional and radiological results of semiconstrained Coonrad-Morrey total elbow arthroplasty for distal humeral nonunions in the mid-term period.
Methods: Seven patients were treated with Coonrad-Morrey total elbow arthroplasty for distal humeral nonunion. All patients were female, and the mean age was 65.6 years (range: 64–68 years). Patients were followed for at least 5 years, and the mean follow-up time was 73 months (range: 63–84 months). Anteroposterior and lateral radiographs at preoperative and early postoperative period of the joint replacement and latest follow-up were used to detect postoperative radiological changes in terms of loosening. The Mayo Elbow Performance Index (MEPI) and Q-DASH Score were used for functional evaluation.
Results: At the latest follow-up, joint stability had been achieved in all 7 patients. Six patients (85.7%) were pain free. The mean range of motion was 30° (range: 0–60°) preoperatively, and this improved to 90.7° (range: 60–110°) at the latest follow-up (p<0.05). Five patients (71.4%) had excellent or good outcomes on the MEPI. The mean Q-DASH Score was improved from 93.2 to 34.5 (p<0.01). Two humeral components had aseptic loosening, and 1 of them was revised.
Conclusion: Semiconstrained total elbow arthroplasty can be a reliable choice of treatment if other internal fixation methods fail. Significant pain relief and improvements in elbow function and stability can be achieved with semiconstrained elbow arthroplasty in patients with distal humeral nonunion.
Keywords
References
- Helfet DL, Kloen P, Anand N, Rosen HS. Open reduction and internal fixation of delayed unions and nonunions of fractures of the distal part of the humerus. J Bone Joint Surg Am 2003;85-A:33–40.
- Jupiter JB. The management of nonunion and malunion of the distal humerus-a 30-year experience. J Orthop Trauma 2008;22:742–50.
- 3 Morrey BF. Fractures of the distal humerus: role of elbow replacement. Orthop Clin North Am 2000;31:145–54.
- Choo A, Ramsey ML. Total elbow arthroplasty: current options. J Am Acad Orthop Surg 2013;21:427–37.
- Park SE, Kim JY, Cho SW, Rhee SK, Kwon SY. Compli- cations and revision rate compared by type of total elbow arthroplasty. J Shoulder Elbow Surg 2013;22:1121–7.
- Morrey BF, Bryan RS, Dobyns JH, Linscheid RL. Total elbow arthroplasty. A five-year experience at the Mayo Clinic. J Bone Joint Surg Am 1981;63:1050–63.
- Cil A, Veillette CJ, Sanchez-Sotelo J, Morrey BF. Linked elbow replacement: a salvage procedure for distal humeral nonunion. J Bone Joint Surg Am 2008;90:1939–50.
- Mitsunaga MM, Bryan RS, Linscheid RL. Condylar non- unions of the elbow. J Trauma 1982;22:787–91.
- Morrey BF, Adams RA. Semiconstrained elbow replace- ment for distal humeral nonunion. J Bone Joint Surg Br 1995;77:67–72.
- Lee BP, Adams RA, Morrey BF. Polyethylene wear af- ter total elbow arthroplasty. J Bone Joint Surg Am 2005;87:1080–7.
- McKee MD, Veillette CJ, Hall JA, Schemitsch EH, Wild LM, McCormack R, et al. A multicenter, prospective, randomized, controlled trial of open reduction-internal fixation versus total elbow arthroplasty for displaced in- tra-articular distal humeral fractures in elderly patients. J Shoulder Elbow Surg 2009;18:3–12.
- Espiga X, Antuña SA, Ferreres A. Linked total elbow ar- throplasty as treatment of distal humerus nonunions in pa- tients older than 70 years. Acta Orthop Belg 2011;77:304– 10.
- LaPorte DM, Murphy MS, Moore JR. Distal humerus nonunion after failed internal fixation: reconstruction with total elbow arthroplasty. Am J Orthop (Belle Mead NJ) 2008;37:531–4.
- Ali A, Shahane S, Stanley D. Total elbow arthroplasty for distal humeral fractures: indications, surgical approach, technical tips, and outcome. J Shoulder Elbow Surg 2010;19(2 Suppl):53–8.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Original Article |
| Authors | |
| Publication Date | August 19, 2015 |
| Published in Issue | Year 2015 Volume: 49 Issue: 4 |