Complex fractures of the distal humerus in the elderly

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1、ComplexfracturesofthedistalhumerusintheelderlyTHEROLEOFTOTALELBOWREPLACEMENTASPRIMARYTREATMENTJ.A.Garcia,R.Mykula,D.StanleyFromtheNorthernGeneralHospital,Sheffield,EnglandBetween1995and2000,19consecutivepatientsNon-operativetreatment(immobilisationinacast,traction,withfracturesofthedistalhu

2、merusweretreatedor‘bagofbones’)oftenresultsineitheraunitedfracturebyprimarytotalelbowreplacementusingthewithjointstiffnessandpoorfunctionornonunionofthe4-8Coonrad-Morreyprosthesis.Nopatienthadfracturewithapainfulpseudarthrosis.inflammatoryordegenerativearthritisoftheelbow.Operativefixationis

3、technicallydifficult.ItusuallyThemeanageatthetimeofinjurywas73years(61involvesalargeexposure,andmayrequireanolecranonto95).AccordingtotheAOclassification,11patientsosteotomytofixanteriorarticularfragments.Inaddition,ifhadsufferedaC3injury,twoaB3andtwoanA3.adequatestabilityisnotachieved,nonuni

4、on,malunion,Onefracturewasunclassified.Twopatientsdiedfrompost-traumaticarthritisandstiffnessofthejointmayresult.9unrelatedcausesandonewasunabletobeassessedJupiterandMorreyreviewed846proceduresfrom13becauseofconcurrentillness.reportsofopenreductionandinternalfixationforfracturesThemeantimeto

5、follow-upwasthreeyears(1toofthedistalhumerusandfoundthat20%ofpatientshadan5.5).Atfollow-up11patients(68%)reportednopain,unsatisfactoryoutcome.four(25%)hadmildpainwithactivityandonehadInelderlypatients,theosteopenicboneandincreasedmildpainatrest.Themeanflexionarcwas24°tocomminutioncompoundth

6、edifficultiesofachievingan125°.Themeansupinationwas90°(70to100)andanatomicalreductionandstablefixation.In1997,Cobband10pronation70°(50to110).Noelbowwasunstable.TheMorreyreportedtheirexperiencesoftotalelbowarthro-meanDisabilitiesoftheArm,ShoulderandHandplasty(TER)in20suchpatientsandconcludedt

7、hatitwasscorewas23(0.92to63.3)andthemeanMayoelbowaneffectivealternativetreatment.Theirstudy,however,performancescorewas93(80to100).Ofthe16comprisedamixedpopulation,withnineofthepatientspatients,15weresatisfiedwiththeoutcome.(tenelbows)sufferingfromrheumatoidart