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Risk Factors for Early Complications in the Operative Treatment of Distal Humerus Fractures in Older Patients
Gleb Medvedev, MD; Richard Amdur, PhD; Robert Neviaser, MD; Andrew Neviaser, MD
George Washington University Medical Center, Washington, DC

Introduction: Open reduction internal fixation (ORIF) and total elbow arthroplasty (TEA) have both been shown as valid options in the treatment of distal humerus fractures in patients over 65 years of age. Risk factors for early complications following these procedures have not been well described.
Materials & Methods: We reviewed the Surgeons National Surgical Quality Improvement Program for both ORIF and TEA performed for distal humerus fractures (Fx-TEA) and TEA for patients with rheumatoid arthritis (RA-TEA) in patients over the age of 65 years between 2006 and 2012. We examined preoperative risk factors and complications within thirty days in each of these three groups.
Results: The sample included 129 ORIF, 28 Fx-TEA, and 14 RA-TEA cases. The ORIF group experienced more early complications than the Fx-TEA group including 5 reoperations, 2 infections, 1 nerve injury, and 10 cases of blood transfusions. In contrast, the TEA group had only 2 cases of blood transfusion. In the ORIF group, preoperative hematocrit and creatinine were significant independent risk factors for complication. The TEA group had two independent risk factors: preoperative hematocrit and presence of a bleeding disorder, including use of anticoagulation. Serious clinical complications in the ORIF, Fx-TEA, and RA-TEA groups were relatively low.
Conclusions: Complications in both groups were low. Low preoperative hematocrit was an independent predictor in both TEA and ORIF groups. Age and weight were not independent predictors but were significant when combined with signs of kidney disease and preoperative anemia for the ORIF group. Identification of these predictors is important to recognize higher risk patients in an already fragile population.

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