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Regaining range of motion is quicker after ORIF
2%
26/1084
Infection is the most common cause of reoperation for TEA
11%
115/1084
There is no difference in TEA longevity between genders
13%
141/1084
Reoperation rates are higher in TEA compared to ORIF
118/1084
TEA survival rates are >75% at 10-years
62%
674/1084
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Several studies have shown satisfactory survival rates >75% at 10 years after total elbow arthroplasty (TEA) for distal humerus fracture. Both TEA and open reduction and internal fixation (ORIF) are options for fixation of elderly distal humerus fractures. In particular, TEA is a viable option for low-demand elderly patients with significantly comminuted, intra-articular fracture patterns that may be at risk for malunion, nonunion, stiffness or post-traumatic arthritis. While there is a lifelong 5 pound lifting limit, several studies have shown maintained survival at 10 years with acceptable outcomes in TEA. This said, there is a risk of complication, most commonly loosening of the prosthesis or bushing wear. McKee et al. published a prospective, randomized trial comparing TEA to ORIF for intra-articular distal humerus fractures in the elderly. They noted significant improvements in the TEA group with regards to ROM and DASH scores and similar rates of reoperation. They concluded that TEA is a preferred treatment option for distal humerus fractures which are intra-articular, comminuted and not amenable to stable fixation. Barco et al. reviewed outcomes of TEA used for distal humerus fractures at 10-years follow-up. They noted that pain, ROM, and outcome scores were all satisfactory and that >75% of patients had survival of their TEA at 10-years; this number increased to >90% in patients without rheumatoid disease. They conclude by reviewing the associated complications and noting that TEA is a reasonable option for elderly patients with complex distal humerus fractures with regards to implant longevity and outcome measures. Incorrect Answers: Answer 1: TEA is generally thought to enable early gains in range of motion to prevent stiffness. Answer 2: Prosthetic loosening is actually the most common complication after TEA for distal humerus fracture with rates described between 10-15%. However, this is often asymptomatic. Answer 3: Male patients have a higher risk of revision surgery at 10 years. Answer 4: Reoperation after TEA and ORIF occur for different reasons, but with similar frequency.
4.3
(6)
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