Portal de Periódicos da CAPES

2

2007; Elsevier BV; Volume: 16; Issue: 2 Linguagem: Inglês

10.1016/j.jse.2007.02.051

1532-6500

Mark A. Mighell, Nazeem A. Virani, Mark A. Frankle, Derek Pupello,

Shoulder and Clavicle Injuries

Background: Failed open reduction and internal fixation (ORIF) of elbow fractures with post-traumatic arthritis is a difficult problem to treat. In some patients, where revision ORIF cannot be adequately performed due to articular incongruity and/or inadequate good quality bone, total elbow arthroplasty (TEA) may be used as a salvage procedure. We report on the outcomes of 28 patients that were salvaged to a TEA after failed attempts at internal fixation. Materials and Methods: Between August 1992 and August 2004, 28 patients underwent TEA after failed internal fixation. There were 26 females and 2 males who underwent a total of 36 attempts at internal fixation prior their index elbow arthroplasty. Average age at injury was 66 years (range 28-79 years). Conversion to arthroplasty was performed at an average of 12 months after the last attempt at internal fixation. Average follow-up from date of index TEA was 36 months (range 7-96 months). Patient outcomes after arthroplasty were evaluated clinically and radiographically. American Shoulder and Elbow Surgeons (ASES) scores for pain and function were obtained after the last attempt at internal fixation and after elbow arthroplasty. Results: Total ASES scores improved from 35.9 after the last attempt at internal fixation to 65 after elbow arthroplasty. Mean ASES pain scores improved from 22 to 35.7. Mean ASES function scores improved from 13.7 to 29.3. All improvements in ASES scores were statistically significant (p<0.05). Postoperatively, an improvement in motion was seen in the majority of patients with a mean arc of motion of 111 degrees (range 30 degrees – 150 degrees). Complications included 1 deep infection and 5 cases of aseptic loosening of the components. The 5 patients with loosening were successfully revised, while the patient with deep infection was ultimately converted to an arthrodesis after a failed revision attempt. Conclusion: TEA is a salvage procedure for failed internal fixation, leading to significant improvements in pain and function. The high rate of component loosening, which is of concern, may be related to the increased pathology and technical difficulty of elbow joint arthroplasty in the setting of prior failed internal fixation. If noted, the author indicates something of value received. The codes are identified as follows: a, research or institutional support; b, miscellaneous funding; c, royalties; d, stock options; e, consultant or employee. *The Food and Drug Administration has not cleared the drug and/or medical device for the use described in this presentation (ie, the drug or medical device is being discussed for an “off-label” use). If noted, the author indicates something of value received. The codes are identified as follows: a, research or institutional support; b, miscellaneous funding; c, royalties; d, stock options; e, consultant or employee. *The Food and Drug Administration has not cleared the drug and/or medical device for the use described in this presentation (ie, the drug or medical device is being discussed for an “off-label” use).