American Association for Hand Surgery
Theme: Beyond Innovation

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Complications of Early Versus Delayed Total Elbow Arthroplasty(TEA) in the Treatment of Distal Humerus Fractures.
David Macknet, MD1; Patrick Marinello, MD2; Bryan Loeffler, MD2; Glenn Gaston, MD2
1Atrium Health, Charlotte, NC, 2OrthoCarolina Hand Center, Charlotte, NC

Introduction:
Acute treatment of distal humerus fractures with TEA resulted in a higher incidence of reoperation compared to delayed treatment while having similar rates of wound complications and heterotopic ossification(HO).
Materials & Methods:
We retrospectively reviewed 76 patients who had TEA performed at our institution within 1 year of a distal humerus fracture. This group was divided into 2 cohorts: the acute group, 51 patients, had TEA performed within 2 weeks of injury; the chronic group, 25 patients, had treatment between 2 weeks and 1 year. We calculated the wound complication, heterotopic ossification, and reoperation rates at final follow up.
Results:
The demographics were similar between groups with an average age of 72 at time of injury. The overall rate of HO at 47.3% (36/76) was not significantly different between groups (p=0.172). Likewise, the rate of wound complications 17.1% (13/76) did not vary between cohorts (p=0.748). There was a higher rate of clinically significant HO (requiring excision or loss functional range of motion) occurring in 25.5% (13/51) of the acute group versus 8.0% (2/25) in the delayed(p=0.12). The overall reoperation rate was 18.4% (14/76) occurring in 25.5% (13/51) of the acute group and 4.0% (1/25) in the delayed group (p=0.027).
Conclusions:
TEA for distal humerus fractures results in a high rate of HO and wound complications. Acute treatment of these fractures with TEA results in a higher rate of reoperation and clinically significant HO when compared to delayed treatment.


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