For Publishers
DiscoveryMetadataPeer reviewHostingPublishing
For Researchers
JoinPublishReviewCollect
Register
Blog
About
Search
Advanced search
My ScienceOpen
Search
For Publishers
For Researchers
Blog
About
5
views
30
references
 Top references
cited by
2
    
0 reviews
 Review
0
comments
 Comment
0
recommends
+1 Recommend
0 collections
    0
    shares
      168
      similar
       All similar
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      A Limited Fixation, Olecranon Sparing Approach, for Management of Geriatric Intra-Articular Distal Humerus Fractures

      research-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Purpose:

          We propose that geriatric comminuted intra-articular distal humerus fractures can be effectively treated with a limited fixation approach aimed at achieving varus/valgus stability with columnar fixation, but allowing intra-articular comminution to heal by secondary congruency against an intact olecranon, thus avoiding an olecranon osteotomy.

          Methods:

          Fifty-six elderly patients with AO 13-C type fractures, who underwent surgical fixation with ≥12-months of follow-up were retrospectively reviewed. Thirty patients were treated with intra-articular open reduction internal fixation (ORIF) with an olecranon osteotomy and 26 patients were treated with our limited fixation (L-ORIF) approach. Outcomes were range of motion (ROM), complications, additional surgery, and patient-reported outcome measures (PROMIS).

          Results:

          At final follow-up, the average elbow ROM was 97° (40°-155°) in the ORIF group and 86.5° (20°-145°) in the L-ORIF group. There was a trend toward more complications and additional surgery in the ORIF group. PROMIS scores for pain were 53.1 and 52.14, and PROMIS functional scores were 41.7 and 41.4 in the ORIF and L-ORIF group respectively. No differences in outcomes were statistically significant.

          Conclusion:

          A limited fixation technique based on achieving varus/valgus stability with columnar fixation, demonstrated equivalent outcomes in elderly patients with intra-articular distal humerus fractures when compared to intra-articular ORIF with an olecranon osteotomy

          Related collections

          Most cited references30

          • Record: found
          • Abstract: found
          • Article: not found

          Establishing a common metric for depressive symptoms: linking the BDI-II, CES-D, and PHQ-9 to PROMIS depression.

          Seung W. Choi, Benjamin D. Schalet, Karon Cook … (2014)
          Interest in measuring patient-reported outcomes has increased dramatically in recent decades. This has simultaneously produced numerous assessment options and confusion. In the case of depressive symptoms, there are many commonly used options for measuring the same or a very similar concept. Public and professional reporting of scores can be confused by multiple scale ranges, normative levels, and clinical thresholds. A common reporting metric would have great value and can be achieved when similar instruments are administered to a single sample and then linked to each other to produce cross-walk score tables (e.g., Dorans, 2007; Kolen & Brennan, 2004). Using multiple procedures based on item response theory and equipercentile methods, we produced cross-walk tables linking 3 popular "legacy" depression instruments-the Center for Epidemiologic Studies Depression Scale (Radloff, 1977; N = 747), the Beck Depression Inventory-II (Beck, Steer, & Brown, 1996; N = 748), and the 9-item Patient Health Questionnaire (Kroenke, Spitzer, & Williams, 2001; N = 1,120)-to the depression metric of the National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS; Cella et al., 2010). The PROMIS Depression metric is centered on the U.S. general population, matching the marginal distributions of gender, age, race, and education in the 2000 U.S. census (Liu et al., 2010). The linking relationships were evaluated by resampling small subsets and estimating confidence intervals for the differences between the observed and linked PROMIS scores; in addition, PROMIS cutoff scores for depression severity were estimated to correspond with those commonly used with the legacy measures. Our results allow clinicians and researchers to retrofit existing data of 3 popular depression measures to the PROMIS Depression metric and vice versa.
          Article 0 comments Cited 144 times – based on 0 reviews     Review now
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Preoperative PROMIS Scores Predict Postoperative Success in Foot and Ankle Patients.

            Judith Baumhauer, Adolph Flemister, John Ketz … (2016)
            The use of patient-reported outcomes continues to expand beyond the scope of clinical research to involve standard of care assessments across orthopedic practices. It is currently unclear how to interpret and apply this information in the daily care of patients in a foot and ankle clinic. We prospectively examined the relationship between preoperative patient-reported outcomes (PROMIS Physical Function, Pain Interference and Depression scores), determined minimal clinical important differences for these values, and assessed if these preoperative values were predictors of improvement after operative intervention.
            Article 0 comments Cited 65 times – based on 0 reviews     Review now
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              A multicenter, prospective, randomized, controlled trial of open reduction--internal fixation versus total elbow arthroplasty for displaced intra-articular distal humeral fractures in elderly patients.

              Michael D McKee, Christian Veillette, Jeremy Hall … (2015)
              We conducted a prospective, randomized, controlled trial to compare functional outcomes, complications, and reoperation rates in elderly patients with displaced intra-articular, distal humeral fractures treated with open reduction-internal fixation (ORIF) or primary semiconstrained total elbow arthroplasty (TEA). Forty-two patients were randomized by sealed envelope. Inclusion criteria were age greater than 65 years; displaced, comminuted, intra-articular fractures of the distal humerus (Orthopaedic Trauma Association type 13C); and closed or Gustilo grade I open fractures treated within 12 hours of injury. Both ORIF and TEA were performed following a standardized protocol. The Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) score were determined at 6 weeks, 3 months, 6 months, 12 months, and 2 years. Complication type, duration, management, and treatment requiring reoperation were recorded. An intention-to-treat analysis and an on-treatment analysis were conducted to address patients randomized to ORIF but converted to TEA intraoperatively. Twenty-one patients were randomized to each treatment group. Two died before follow-up and were excluded from the study. Five patients randomized to ORIF were converted to TEA intraoperatively because of extensive comminution and inability to obtain fixation stable enough to allow early range of motion. This resulted in 15 patients (3 men and 12 women) with a mean age of 77 years in the ORIF group and 25 patients (2 men and 23 women) with a mean age of 78 years in the TEA group. Baseline demographics for mechanism, classification, comorbidities, fracture type, activity level, and ipsilateral injuries were similar between the 2 groups. Operative time averaged 32 minutes less in the TEA group (P = .001). Patients who underwent TEA had significantly better MEPSs at 3 months (83 vs 65, P = .01), 6 months (86 vs 68, P = .003), 12 months (88 vs 72, P = .007), and 2 years (86 vs 73, P = .015) compared with the ORIF group. Patients who underwent TEA had significantly better DASH scores at 6 weeks (43 vs 77, P = .02) and 6 months (31 vs 50, P = .01) but not at 12 months (32 vs 47, P = .1) or 2 years (34 vs 38, P = .6). The mean flexion-extension arc was 107 degrees (range, 42 degrees -145 degrees) in the TEA group and 95 degrees (range, 30 degrees -140 degrees) in the ORIF group (P = .19). Reoperation rates for TEA (3/25 [12%]) and ORIF (4/15 [27%]) were not statistically different (P = .2). TEA for the treatment of comminuted intra-articular distal humeral fractures resulted in more predictable and improved 2-year functional outcomes compared with ORIF, based on the MEPS. DASH scores were better in the TEA group in the short term but were not statistically different at 2 years' follow-up. TEA may result in decreased reoperation rates, considering that 25% of fractures randomized to ORIF were not amenable to internal fixation. TEA is a preferred alternative for ORIF in elderly patients with complex distal humeral fractures that are not amenable to stable fixation. Elderly patients have an increased baseline DASH score and appear to accommodate to objective limitations in function with time.
              Article 0 comments Cited 60 times – based on 0 reviews     Review now
                Bookmark
                All references

                Author and article information

                Journal
                Journal ID (nlm-ta): Geriatr Orthop Surg Rehabil
                Journal ID (iso-abbrev): Geriatr Orthop Surg Rehabil
                Journal ID (publisher-id): GOS
                Journal ID (hwp): spgos
                Title: Geriatric Orthopaedic Surgery & Rehabilitation
                Publisher: SAGE Publications (Sage CA: Los Angeles, CA )
                ISSN (Print): 2151-4585
                ISSN (Electronic): 2151-4593
                Publication date (Electronic): 14 August 2020
                Publication date Collection: 2020
                Volume: 11
                Electronic Location Identifier: 2151459320950063
                Affiliations
                [1 ]Ringgold 1859, Harvard Combined Orthopaedic Residency Program; , Boston, MA, USA
                [2 ]Ringgold 1859, Beth Israel Deaconess Medical Center; , Boston, MA, USA
                [3 ]Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA
                [4 ]Ringgold 1861, Brigham and Women’s Hospital; , Boston, MA, USA
                Author notes
                [*]Edward K. Rodriguez, MD, PhD, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, 300 Brookline Avenue, Stoneman 10, Boston, MA 02215, USA. Email: ekrodrig@ 123456bidmc.harvard.edu
                Author information
                https://orcid.org/0000-0002-8217-0593
                Article
                Publisher ID: 10.1177_2151459320950063
                DOI: 10.1177/2151459320950063
                PMC ID: 7430082
                SO-VID: 3e7d334d-2a7d-4b67-bef4-47940d55ff48
                Copyright © © The Author(s) 2020
                License:

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Categories
                Subject: Technical Perspective
                Custom metadata
                cover-date January-December 2020
                typesetter ts3

                Keywords: distal humerus,fracture,elderly,osteoporosis
                Data availability:
                Keywords: distal humerus, fracture, elderly, osteoporosis

                Comments

                Comment on this article

                scite_

                Similar content168

                See all similar

                Cited by2

                See all cited by

                Most referenced authors277

                See all reference authors