AO/OTA B and C articular fractures of the distal humerus: What are the boundaries between Total Elbow Arthroplasty and ORIF?

Background: Nowadays, an increasing number of Total Elbow Arthroplasty (TEA) surgeries have been selected as the primary intervention for distal humerus joint fractures. TEA has demonstrated favorable outcomes in elderly osteoporotic patients and has been associated with fewer complications and reduced stiffness when compared to Open Reduction Internal Fixation (ORIF) surgeries. This retrospective cohort study aimed to analyze differences in terms of functional outcomes, complications, and reoperation rates of distal fractures of the humerus treated with ORIF and TEA. Methods: This is a retrospective cohort study. Inclusion criteria: Closed intra-articular fractures of the distal humerus (AO/OTA type 13B and 13C); age greater than 50 years; clinical and radiological follow-up of at least 2 years. Patients were divided into two groups according to surgical treatments: ORIF and TEA. The following variables were obtained: age, sex, affected side, AO/OTA classification, follow-up time, approach, surgery duration, Range Of Motions, MEPI (Mayo Elbow Performance Index), QUICK DASH (Disability of the Arm, Shoulder, and Hand), post-operative VAS (Visual Analog Scale), satisfaction rate, complications and reoperation rates. Differences in data averages between the groups were assessed, and a correlation between age and other variables in each group was calculated. Results: 83 subjects (26 men and 57 women) were eligible and selected for the study. Average age and follow-up time were 74.8 years (+-10.6) and 83.6 months (+-42.6). Group TEA consisted of 41 patients (37 female, 4 male), mean age of 78.8 (+-8.6) with follow-up time of 83,6 months (+-42.6). Group ORIF consisted of 42 subjects (20 female, 22 male), mean age of 71.1 (+-11.6) with follow-up time of 70,6 months (+-40,6) The cohorts didn't differ significantly with any variables calculated (p > 0.05) except for complication and reoperation rates, which were significantly lower in the TEA group. Age didn't have a correlation trend associated with the variables in either group assessed independently (p > 0.05). Conclusions: The results of the study, may guide in choosing a surgical option for distal humerus fractures in the elderly by considering TEA an alternative that is comparable to ORIF, and in selected cases an alternative that overall provides greater assurance than ORIF.