Total elbow joint replacement for the treatment of distal humerus fracture of type c in eight elderly patients

Abstract

Objective: To analyze the outcomes of total elbow arthroplasty in the treatment of elderly type C distal humeral fractures and discuss the clinic efficacy.

Methods: 8 cases of elderly type C distal humeral fractures, Male was in one case, female in seven cases, and the average age was 66.5 years (60-81). All cases were closed fractures because of falling and none had associated injuries. According to AO classification, type C1 were in one cases, C2 in four cases and C3 in three cases. The average time from injury to operation was 5.5 days (3-9), and the type of prosthesis which all cases replaced was Coonrad-Marrey. The postoperative follow-up was obtained regularly which the contents included Mayo elbow score, pain evaluation, the motion range and the stability of the elbow, muscle strength, examination of related complications such as heterotopic ossification, prosthesis loosening and nerve damage.

Results: The incision infection was in one case, ulnar nerve symptom in two cases, weakness of musculus triceps brachii in one case and mild pain of elbow in two cases. The average motion rage of elbow was 103.5±3.2 degree (78-118) in flexion-extension and 126.4±4.1 degree (94-148) in rotation. All elbow joints were stable postoperatively, no prosthesis loosening and apparent wear was found. The heterotopic ossification was found in 1 case. The average Mayo elbow score was 85.2±3.4 (75-95), four cases of excellent and four cases of good.

Conclusion: The total elbow arthroplasty was recommended in clinic to treat elderly type C distal humeral fractures because the clinic outcomes are satisfied.

Keywords: Humerus; arthroplasty; elbow; fractures; replacement.

Figure 1

Schematic Diagram for Operation Procedure. (A) Use Bryan-Money approach (triceps-reflecting approach); through releasing the Sharpey fiber on olecranon, pull out the musculus triceps brachii from inside to outside; remain the continuity of muscle and the expanded part of its facies lateralis anconeus. Rotate the ulna to expose and use ulnar bone cavity (C). (B, C) For patients with bicondylar comminuted fracture, the approach and the attachment points of triceps can be reserved by using musculus triceps brachii: make the ulnar nerve exposed and move it forwards; excise the broken bone blocks (B) from inside first; then make the lateral epicondyle exposed and peel the whole soft tissues and remove the whole fractured pieces. Rotate the ulna so that ulna medullary cavity (C) can be exposed. (D) Make preparations of synostosis for Coonrad-Morrey typed semi-restricted prosthesis. Install osteotomy template through medullary space alignment positioning system; incise the trochlea humeri of appropriate size. (E) One should notice that the appropriate depth for insertion of prosthesis at ulna side should be that the center of the prosthesis at ulna side be consistent with that of olecranon meniscus incisura. (F) Implantation of Coonrad-Morrey prosthesis. Perform bone grafting at the back of anterior convex wing, and the prosthesis at the side of humerus should be close to the distal end enough so that it can be connected with the prosthesis at the side of ulna. Connect the joint prosthesis by adopting needle-by-needle locking system. After connecting the prosthesis at the side of humerus with the prosthesis at the side of ulna, throw the prosthesis at the side of humerus into the medullary space until its anterior convex wing repains to the top of coronoid process. (G-I) Anastomose and repair of muscle tendon of triceps: use a bone drill to drill crisscrossing and transverse bony tunnelat the distal ulna; use a No. 5 non-absorbable suture to go across the bone tunnel and muscle tendon (G); the suture crossed the muscle tendom and then return to the another bone tunnel (H); j is used for the second transerve suture: strengthen repair (I).

Figure 2

A. A 74 year-old female patient experiencing distal right humerus fracture of type C3 of AO due to falling. B. Coonrad-Morrey elbow joint prosthesis replacement was performed four days after being injured. C. The activity of affected elbow joint basically recovered to normal one year after operation.