Management of acute distal humeral fractures in patients with rheumatoid arthritis: A case series

Bernhard Jost, Robert A. Adams, Bernard F. Morrey

Research output: Contribution to journalArticlepeer-review

27 Scopus citations

Abstract

Background: The best surgical treatment for a patient with rheumatoid arthritis and an acute distal humeral fracture is not well established. Because of the distorted anatomy of the arthritic elbow joint and the adjacent osteoporotic bone, total elbow arthroplasty may be favored over open reduction and internal fixation in these patients. We retrospectively analyzed a series of patients with rheumatoid arthritis in whom an acute distal humeral fracture had been treated with either open reduction and internal fixation or total elbow arthroplasty; our purpose was to evaluate their outcomes and to identify any influence of age, fracture type, or the extent of the rheumatoid involvement of the elbow joint on the choice of procedure. Methods: Between 1982 and 2002, an acute distal humeral fracture was treated surgically in sixteen elbows in fourteen patients with rheumatoid arthritis, and the results were retrospectively reviewed at a minimum of twenty-four months postoperatively. Six elbows were treated with open reduction and internal fixation (Group 1) and ten elbows, with primary total elbowarthroplasty (Group2). Postoperatively, the elbowswere examined with standard radiographs, and the clinical outcome was assessed with the Mayo Elbow Performance Score (MEPS). Results: Six patients (six elbows) died before the time of the study, but they had been followed formore than twenty-fourmonths and therefore were included in the series. The eight patients (ten elbows) who were still alive were examined. Themean duration of follow-up was forty-nine months in Group 1 and sixty-six months in Group 2. The MEPS averaged 93 points in Group 1 and 96 points in Group 2. Radiographically, all fractures had healed uneventfully in Group 1 and no prosthesis was loose in Group 2. We could not identify any difference between Groups 1 and 2 with respect to patient age, fracture type, or extent of the rheumatoid arthritis. Conclusions: Distal humeral fractures in patients with rheumatoid arthritis can be treated successfully with immediate open reduction and internal fixation or with total elbowarthroplasty. Our data suggest that open reduction and internal fixation can be successful when there is mild arthritic involvement. Wefavor total elbow arthroplasty for patients with severe articular involvement. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)2197-2205
Number of pages9
JournalJournal of Bone and Joint Surgery - Series A
Volume90
Issue number10
DOIs
StatePublished - Oct 1 2008
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Fingerprint Dive into the research topics of 'Management of acute distal humeral fractures in patients with rheumatoid arthritis: A case series'. Together they form a unique fingerprint.

Cite this