The Outcome of Perioperative Humeral Condylar Fractures after Total Elbow Replacement in Patients with Rheumatoid Arthritis

Author(s): Ito H, Matsumoto T, Yoshitomi H, Kakinoki R, Nakamura T

Source: J Bone Joint Surg  89B:62-65, 2007.

Summary:

Total elbow arthroplasty is not uncommonly indicated for patients with rheumatoid arthritis.  The Coonrad-Morrey semiconstrained device is the most widely utilized implant.  Periarticular osteoporosis is common with rheumatoid arthritis and inevitably makes the bones more vulnerable to fractures during surgery.  Insertion of the humeral component of this implant can result in a condylar fracture.  This is especially true in Asian people who often have smaller bones.  The authors attempt to compare the outcome of their patients who underwent total elbow arthroplasty using this implant comparing patients who sustained a fracture of the condyle with those who did not sustain any fracture.

This was a retrospective review and included 40 total elbow replacements in 37 patients.  The patients were divided into two groups.  One group consisted of patients that did not have a condylar fracture (n=27).  The other group sustained a humeral condylar fracture either during or within the two weeks after operation (n=13).  A fracture was defined as a condyle which had been displaced, removed, or fixed internally.  A minimum follow-up of one-year was used.  The mean follow-up was 4.7 years.  Clinical and radiographic criteria were used as outcome measures.  There were no statistical differences between the two groups with regard to demographics.

At follow-up, the Mayo Elbow Performance Score was similar between groups.  Manual muscle testing was slightly lower in the fracture group but attributed to a patient with triceps insufficiency rather than the fracture of the condyle.  There was no statistically difference with regard to radiological criteria between groups.

In this study, condylar fractures incurred in 13 out of 40 or 33% of patients.  This ratio is high and was attributed to the large implants compared to the smaller size of Asian patients.  In 2002, a smaller implant was introduced which has decreased fracture incidence.  Regardless, the occurrence of a fracture condyle in the perioperative period did not appear to influence outcome in the short term.  The authors did not provide recommendations for when to fix or excise the condyle.

 

Rheumatoid, Arthritis, Total, Elbow, Arthroplasty, Condyle, Fracture


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