Trends, complications, and comorbidity risk in total elbow arthroplasty versus open reduction and internal fixation for distal humerus fractures

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-05-20 DOI:10.1016/j.jcot.2025.103062

David H. Jung , Senthooran Kalidoss , Douglas Zhang , Sahil Sethi , Daniel A. Hu , Jason A. Strelzow

{"title":"Trends, complications, and comorbidity risk in total elbow arthroplasty versus open reduction and internal fixation for distal humerus fractures","authors":"David H. Jung , Senthooran Kalidoss , Douglas Zhang , Sahil Sethi , Daniel A. Hu , Jason A. Strelzow","doi":"10.1016/j.jcot.2025.103062","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Treatment of distal humerus fractures (DHF) in older patients presents challenges due to high complication rates. Total elbow arthroplasty (TEA) has emerged as an alternative to open reduction and internal fixation (ORIF). This study investigates trends, outcomes, and risk factors associated with TEA and ORIF for the treatment of DHF.</div></div><div><h3>Methods</h3><div>Using the PearlDiver Mariner database, patients aged 55 years and older treated with either TEA or ORIF for DHF between 2010 and 2021 were identified. Trends in procedure volume, 90-day complications (postoperative bleeding, wound disruption, thromboembolic events, infection), and 12-month revision rates were analyzed. Risk factors (age, gender, diabetes, tobacco use, obesity, chronic kidney disease) were assessed using exact matching (1:4 ratio) and multivariable logistic regression.</div></div><div><h3>Results</h3><div>A total of 16,572 patients were reviewed, including 1825 treated with TEA and 14,747 with ORIF. TEA utilization peaked in 2014 but declined thereafter. Both TEA and ORIF showed decreased complication and revision rates over time. After exact matching (n = 8989; 1800 TEA, 7189 ORIF), TEA was associated with significantly higher 90-day postoperative bleeding (OR: 2.51, <em>p</em> < 0.001) and infection rates (OR: 1.83, <em>p</em> < 0.0001). Multivariable logistic regression showed that tobacco use increased wound disruption (OR: 1.71, <em>p</em> = 0.002), while chronic kidney disease was a predictor of infection (OR: 1.62, <em>p</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>TEA utilization for DHF has declined, possibly due to its association with a 2.5-fold higher risk of postoperative bleeding and 1.8-fold higher risk of infection compared to ORIF. Further assessment of treatment trends and their impact on clinical practice is needed.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"68 ","pages":"Article 103062"},"PeriodicalIF":0.0000,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Orthopaedics and Trauma","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0976566225001602","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Treatment of distal humerus fractures (DHF) in older patients presents challenges due to high complication rates. Total elbow arthroplasty (TEA) has emerged as an alternative to open reduction and internal fixation (ORIF). This study investigates trends, outcomes, and risk factors associated with TEA and ORIF for the treatment of DHF.

Methods

Using the PearlDiver Mariner database, patients aged 55 years and older treated with either TEA or ORIF for DHF between 2010 and 2021 were identified. Trends in procedure volume, 90-day complications (postoperative bleeding, wound disruption, thromboembolic events, infection), and 12-month revision rates were analyzed. Risk factors (age, gender, diabetes, tobacco use, obesity, chronic kidney disease) were assessed using exact matching (1:4 ratio) and multivariable logistic regression.

Results

A total of 16,572 patients were reviewed, including 1825 treated with TEA and 14,747 with ORIF. TEA utilization peaked in 2014 but declined thereafter. Both TEA and ORIF showed decreased complication and revision rates over time. After exact matching (n = 8989; 1800 TEA, 7189 ORIF), TEA was associated with significantly higher 90-day postoperative bleeding (OR: 2.51, p < 0.001) and infection rates (OR: 1.83, p < 0.0001). Multivariable logistic regression showed that tobacco use increased wound disruption (OR: 1.71, p = 0.002), while chronic kidney disease was a predictor of infection (OR: 1.62, p < 0.001).

Conclusion

TEA utilization for DHF has declined, possibly due to its association with a 2.5-fold higher risk of postoperative bleeding and 1.8-fold higher risk of infection compared to ORIF. Further assessment of treatment trends and their impact on clinical practice is needed.

查看原文本刊更多论文

肱骨远端骨折全肘关节置换术与切开复位内固定的趋势、并发症和合并症风险

背景：由于并发症发生率高，老年患者肱骨远端骨折（DHF）的治疗面临挑战。全肘关节置换术（TEA）已成为切开复位内固定（ORIF）的替代方法。本研究调查了与TEA和ORIF治疗DHF相关的趋势、结果和危险因素。方法使用PearlDiver Mariner数据库，识别2010年至2021年间接受TEA或ORIF治疗的55岁及以上DHF患者。分析了手术量、90天并发症（术后出血、伤口破裂、血栓栓塞事件、感染）和12个月翻修率的趋势。危险因素（年龄、性别、糖尿病、吸烟、肥胖、慢性肾脏疾病）采用精确匹配（1:4比例）和多变量logistic回归进行评估。结果共纳入16572例患者，其中TEA组1825例，ORIF组14747例。TEA的利用率在2014年达到顶峰，但此后有所下降。随着时间的推移，TEA和ORIF的并发症和翻修率都有所下降。精确匹配后(n = 8989；TEA为1800，ORIF为7189)，TEA与术后90天出血显著升高相关(OR: 2.51, p <；0.001)和感染率(OR: 1.83, p <；0.0001)。多变量logistic回归显示，吸烟增加伤口破裂（OR: 1.71, p = 0.002），而慢性肾脏疾病是感染的预测因子(OR: 1.62, p <；0.001)。结论与ORIF相比，tea的术后出血风险高2.5倍，感染风险高1.8倍，可能是DHF患者tea使用率下降的原因。需要进一步评估治疗趋势及其对临床实践的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.