Total elbow arthroplasty provides superior outcomes for humeral fractures in the elderly .
This report has been verified
by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(5):67 J Shoulder Elbow Surg. 2009 Jan-Feb;18(1):3-12. Epub 2008 Sep 2642 elderly patients with displaced intra-articular, distal humeral fractures were managed using open reduction and internal fixation (ORIF) or with total elbow arthroplasty (TEA). Assessment 2 years post-operatively supported the use of TEA in this elderly population. MEPS scores were significantly better in the TEA group, while DASH sores were superior during early follow-ups. These findings were accompanied by a trend towards a reduction in complications in the TEA group.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
نعم = 1
غير مؤكد = 0.5
غير ذي صلة = 0
لا = 0
يقيّم تقييم معايير الإبلاغ الشفافية التي يبلغ بها المؤلفون عن الخصائص المنهجية والتجريبية للتجربة في المنشور. ينقسم التقييم إلى خمس فئات معروضة أدناه.
4/4
Randomization
3/4
Outcome Measurements
2/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
مؤشر الهشاشة هو أداة تساعد في تفسير النتائج المهمة، وتوفر مقياسًا لقوة النتيجة. ويمثل مؤشر الهشاشة عدد الأحداث المتتالية التي يجب إضافتها إلى نتيجة ثنائية التفرع لجعل النتيجة غير مهمة. يمثل الرقم الصغير نتيجة أضعف ويمثل الرقم الكبير نتيجة أقوى.
لماذا كانت هناك حاجة لهذه الدراسة الآن؟
Currently, the gold standard of treatment for displaced intra-articular, distal humeral fractures in young patients is open reduction and internal fixation (ORIF). The use of ORIF in the elderly is associated with less predictable outcomes, increasing the number of complications. Total elbow arthroplasty is an established treatment option for revision of internal fixation and may provide superior outcomes, if used as a primary treatment in this elderly population.
ما هو سؤال البحث الرئيسي؟
Did open reduction and internal fixation or total elbow arthroplasty provide the best clinical and functional outcomes for elderly patients with displaced intra-articular, distal humeral fractures, when measured over a 2 year period?
- Intra-operative conversion between groups resulted in 16 patients receiving ORIF and 26 patients receiving TEA; 5 patient randomized to ORIF received TEA due to severe fracture comminution.
- The mean operative time was significantly shorter for the TEA group (108 +/- 21 minutes) in comparison to the ORIF group (140 +/- 38 minutes) (p=0.001).
- The mean duration of hospitalization was shorter for the TEA group (7.7 +/- 6.3 days), compared to the ORIF group (9.3 +/- 9.7 days), but this difference did not reach statistical significance (p=0.5).
- Patients who underwent TEA had significantly better MEPS scores at 3 , 6, 12, and 24 month follow-up (p=0.01, p=0.003, p=0.01, p=0.015, respectively).
- DASH scores at 6 week and 6 month follow-up assessments were significantly better in the TEA group (6 weeks: 43; 6 months: 31), compared to the ORIF group (6 weeks: 77; 6 months: 47) (6 weeks: p=0.02; 6 months: p=0.04)
- Re-operation rates were not significantly different between the ORIF group (27%, 4/15 patients) and TEA group (12%, 3/25 patients) (p=0.2)
ما الذي يجب أن أتذكره أكثر؟
Total elbow arthroplasty resulted in significantly better MEPS at two years and provided superior DASH scores during early follow-up assessments, in comparison to those who received open reduction-internal fixation. These positive results were also accompanied by a trend towards fewer revision surgeries.
كيف سيؤثر ذلك على رعاية مرضاي؟
Total elbow arthroplasty is a preferable treatment option for elderly patients with displaced intra-articular, distal humeral fractures, providing superior clinical and functional outcomes.
تنويه
هذا المحتوى الموجود في هذه الصفحة هو لأغراض إعلامية فقط وليس الغرض منه أن يكون بديلاً عن المشورة الطبية المتخصصة أو التشخيص أو العلاج. إذا كنت بحاجة إلى علاج طبي، اطلب دائمًا مشورة طبيبك أو اذهب إلى أقرب قسم طوارئ إليك. الآراء والمعتقدات ووجهات النظر التي يعبر عنها الأفراد في المحتوى الموجود في هذه الصفحة لا تعكس آراء ومعتقدات ووجهات نظر أورثوإيفيدنس.
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