Journal of Orthopaedics, Trauma and Rehabilitation (Jun 2018)

Total Elbow Arthroplasty Gives Good Functional Outcome in Distal Humerus Fracture with Pre-existing Chronic Elbow Dislocation

  • Hing Shing Chan,
  • Sheung Tung Ho

Journal volume & issue
Vol. 24
pp. 60 – 65

Abstract

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Distal humerus fracture with concomitant chronic elbow dislocation is difficult to manage by open reduction and internal fixation, while total elbow arthroplasty (TEA) is an effective treatment for acute fracture or failed internal fixation of distal humerus fracture in elderly patients with osteoporosis. We present a case of an 86-year-old woman who suffered from acute distal humerus fracture in the presence of chronic elbow deformity from elbow dislocation since childhood at the age of 10 years. This was treated with TEA using Coonrad/Morrey prosthesis with long stem and long flange humerus components and cerclage wiring of humeral condyle. Postoperatively, elbow mobilization was started early within a hinged elbow brace. There was no operative complication. At the last follow-up 22 months after surgery, there was no pain and good elbow motion (20–130° flexion–extension arc, full supination and pronation to neutral) was obtained. The Mayo Elbow Performance Score was 100. There was incorporation of the bone graft at the anterior flange with no radiographic loosening of the prosthesis. This case shows that TEA can yield a gratifying clinical result and efficiently resolves two problems with one solution. 中 文 摘 要: 遠端肱骨骨折並伴有長期肘關節脫位是難以開放復位及內固定處理,而全肘關節置換是一個用於老年及骨質疏鬆症患者的急性遠端肱骨骨折或骨折內固定失敗的有效治療。我們報告一位從10歲 起患有長期肘關節脫位及畸形,86歲時發生急性遠端肱骨骨折。使用長桿和長凸緣肱骨組件的Coonrad/Morrey人工假體和利用金屬線環紥肱骨髁進行肘關節置換。術後使用鉸鏈肘護托展開早期肘關節活動。手術後沒有併發症。術後22個月的最後隨訪中,沒有疼痛,肘活動良好 (20°-130° 屈曲伸展弧度、完全前旋、後旋至中立位置) 。梅奧肘關節功能評分為100分。放射線造影見到凸緣處移植骨的結合而假體沒有鬆動。這個案例表明肘關節置換可提供令人滿意的臨床效果,並且可以用一個方案很好地解決两個問題。 Keywords: chronic elbow dislocation, distal humerus fracture, elderly, total elbow arthroplasty