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)?
Sì = 1
Incerto = 0,5
Non rilevante = 0
No = 0
La valutazione dei criteri di segnalazione valuta la trasparenza con cui gli autori riportano le caratteristiche metodologiche e sperimentali dello studio all'interno della pubblicazione. La valutazione è suddivisa in cinque categorie che vengono presentate di seguito.
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
L'Indice di Fragilità è uno strumento che aiuta l'interpretazione dei risultati significativi, fornendo una misura della forza di un risultato. L'Indice di Fragilità rappresenta il numero di eventi consecutivi che devono essere aggiunti a un risultato dicotomico per rendere il risultato non più significativo. Un numero piccolo rappresenta un risultato più debole, mentre un numero grande rappresenta un risultato più forte.
Perché questo studio era necessario ora?
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.
Qual era la domanda di ricerca principale?
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)
Che cosa devo ricordare di più?
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.
Come influenzerà l'assistenza ai miei pazienti?
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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