Classification-based treatment of periprosthetic fractures around total elbow arthroplasty: a systematic review and meta-analysis.

Introduction: Treatment of periprosthetic fractures around the elbow remains a challenge. The goal of this study was to present classification-based treatment strategies of periprosthetic fractures around elbow prosthesis.

Methods: This study was designed as a systematic review and meta-analysis of published articles in English or German language that investigated classification systems and treatment strategies of fractures around elbow prosthesis without timeframe limitations. Articles without full-text availability were excluded. The search included the following data bases: Medline, EMBASE, Cochrane and Web of Science (WoS). The fractures where classified according to the most commonly utilized classification system. Outcome parameters included follow-up time, bone union and range of motion. After deduplication title and abstract screening and full-text analyses were performed by two independent researchers. Risk of bias assessment was performed with the Revised Cochrane risk of bias tool (ROBINS 1) for non-randomized studies.

Results: This systematic review included 26 articles that included 11 reviews (42.3%), 12 case reports (46.1%) and 3 (11.6%) cohort studies. In total 85 patients were included with a mean age of 68.7 (SD 11.1) years. Most patients were female (n = 61, 73.5%). Fractures were all classified according to Mayo classification. In most reports, type 1 fractures without stem loosening were treated non-operatively, type 2 and 3 fractures without stem loosening with fracture fixation, type 2 fractures with stem loosening with revision arthroplasty. The time to bone union was comparable in fracture fixation versus revision surgery (18.2, SD 9.4 weeks vs. 12.3, SD 5.4 weeks, p = 0.294). The degree/ (or range) of extension was comparable in both groups (9.8, SD 11.2° versus 17.4, SD 16.6°, p = 0.335). The degree of flexion was comparable in both groups (117.5, SD 15.1° versus 127.9, SD 10.3°, p = 0.335).

Conclusion: Treatment of periprosthetic fractures around elbow arthroplasty remains a challenge. The treatment strategy is based on the location of the fracture and the stability of the elbow prosthesis. The lack of high-quality research prohibits a final evidence- based recommendation for the treatment of periprosthetic fractures around the elbow.