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)?
Ja = 1
Ungewiss = 0.5
Nicht relevant = 0
Nein = 0
Die Bewertung der Berichtskriterien bewertet die Transparenz, mit der die Autoren die methodischen und studienspezifischen Merkmale der Studie in der Veröffentlichung angeben. Die Bewertung ist in fünf Kategorien unterteilt, die im Folgenden vorgestellt werden.
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
Der Fragilitätsindex ist ein Instrument, das bei der Interpretation signifikanter Ergebnisse hilft und ein Maß für die Stärke eines Ergebnisses liefert. Der Fragilitätsindex gibt die Anzahl der aufeinanderfolgenden Ereignisse an, die zu einem dichotomen Ergebnis hinzugefügt werden müssen, damit das Ergebnis nicht mehr signifikant ist. Eine kleine Zahl steht für ein schwächeres Ergebnis und eine große Zahl für ein stärkeres Ergebnis.
Warum wurde diese Studie jetzt benötigt?
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.
Was war die wichtigste Forschungsfrage?
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)
Was sollte ich mir besonders merken?
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.
Wie wird sich dies auf die Behandlung meiner Patienten auswirken?
Total elbow arthroplasty is a preferable treatment option for elderly patients with displaced intra-articular, distal humeral fractures, providing superior clinical and functional outcomes.
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