Comparison of the Complications, Reoperations, and Clinical Outcomes between Open Reduction and Internal Fixation and Total Elbow Arthroplasty for Distal Humeral Fractures in the Elderly: A Systematic Review and Meta-Analysis

Abstract

Distal humeral fractures are challenging injuries seen in the elderly. Open reduction and internal fixation (ORIF) are the gold standard treatments. Total elbow arthroplasty (TEA) is an alternative to ORIF. This study aimed to pool and analyze the outcomes and complications in elderly patients with distal humeral fractures treated with either ORIF or TEA by performing a meta-analysis. We searched the PubMed, Embase, Google Scholar, and Cochrane Library databases for studies that compared the clinical and functional outcomes of ORIF and TEA in patients aged 60 years or older. After screening and performing a quality assessment of the articles, we obtained one randomized control study and nine retrospective comparative studies. The odds ratio and standardized mean difference were used to analyze the differences in outcomes between the two surgical options. In terms of the flexion/extension arc, TEA produced significantly better outcomes than ORIF (p = 0.02). The rates of reoperation and elbow stiffness were significantly lower in the TEA group than in the ORIF group (p = 0.003 and p = 0.04, respectively). However, the functional scores and other ranges of motion (flexion, loss of extension, pronation, supination) after surgery were similar between the two groups. The outcomes from the present meta-analysis can provide guidance when selecting a surgical option for distal humeral fractures in the elderly.

Keywords: distal humeral fracture; elderly; meta-analysis; open reduction and internal fixation; plate osteosynthesis; total elbow arthroplasty; total elbow replacement.

Figure 1

Flow chart for literature identification using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Figure 2

Results of the meta-analysis with respect to the functional scores: (A) MEPS, and (B) DASH [5,10,21,24,27]. MEPS: Mayo Elbow Performance score; DASH: Disabilities of the Arm, Shoulder, and Hand; ORIF: open reduction and internal fixation; TEA: total elbow arthroplasty; SD: standard deviation.

Figure 3

Results of the meta-analysis with respect to the range of motions: (A) flexion/extension arc, (B) flexion, (C) loss of extension, (D) pronation, and (E) supination [5,21,24,27]. ORIF: open reduction and internal fixation; TEA: total elbow arthroplasty; SD: standard deviation.

Figure 4

Results of the meta-analysis with respect to reoperation and total complications: (A) reoperation and (B) total complications [5,10,20,21,24,25,26,27,28,29]. ORIF: open reduction and internal fixation; TEA: total elbow arthroplasty.

Figure 5

Results of the meta-analysis with respect to each complication: (A) wound dehiscence, (B) heterotopic ossification, (C) ulnar nerve problem, (D) infection, and (E) elbow stiffness [5,10,21,24,25,26,27,28,29]. ORIF: open reduction and internal fixation; TEA: total elbow arthroplasty.