Arthroplasty compared to internal fixation by locking plate osteosynthesis in comminuted fractures of the distal humerus

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Abstract
The purpose of this study was to evaluate and compare the results after double locking plate osteosynthesis (ORIF) and total elbow arthroplasty (TEA) in AO type C fractures of the distal humerus. This retrospective study includes clinical results of 29 patients (9xTEA, 20xORIF) with a mean age of 62 years. The male to female ratio was 8:21. Range of motion, MEPS, DASH and complications were evaluated. Patients older than 60 years (n = 19) were filtered and compared statistically. After a mean follow-up of 25 months the ORIF-group reached an extension-flexion of 99°±23° and the TEA-group of 111°±13°. The ORIF-group vs. the TEA-group had a mean MEPS of 85±17 vs. 94±11 and DASH of 34±24 vs. 24±12. In patients older than 60 years extension-flexion was 97°±23° after ORIF and 110°±14 after TEA (p = 0.237). The ORIF-group vs. the TEA-group had a mean MEPS of 82±21 vs. 94±11 (p = 0.078) and DASH of 45±18 vs. 26±11 (p = 0.023). The ORIF-group had a 4.4 times higher risk for major complications. TEA and ORIF lead to comparable functional results, but major complications are more common after ORIF. Despite this, ORIF remains the gold standard for younger and older patients because of the lifelong loading limitation after TEA, unknown implant survival and problematic revision surgery. For patients older than 60 years a primary TEA can be recommended in exceptional cases, if the loading limitation is acceptable for the individual or the fracture is not reconstructable.

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