Purpose
The purpose of this study was to compare the rates of wound complications and heterotopic
ossification (HO) between patients who underwent acute total elbow arthroplasty (TEA)
and those who underwent delayed TEA performed for the treatment of distal humerus
fractures. Our hypothesis was that delayed surgery will have fewer wound complications
but a higher rate of HO.
Methods
We retrospectively reviewed 104 patients who had undergone TEA performed at 1 of 3
institutions following a distal humerus fracture. The acute cohort, comprising 69
patients, underwent TEA within 2 weeks; the delayed cohort, comprising 35 patients,
received treatment between 2 weeks and 6 months. The rates of wound complications,
HO, clinically relevant HO (requiring excision or resulting in loss of functional
range of motion), and reoperation were recorded. These patients were followed up for
an average of 52 (interquartile range, 18.5–117) weeks.
Results
Wound complications occurred in 10 patients (14.5%) in the early group and 7 (20.0%)
in the delayed group. The overall rate of HO was 56.7% (59 patients). The rate of
clinically relevant HO was 26.0% (27 patients), which was similar between the groups.
Reoperation occurred in 20 patients (19.2%), which was similar between the groups.
In the early group, 3 reoperations were performed for wound complications and 4 for
HO. No patients required reoperation for these indications in the delayed group. The
mean flexion-extension and supination-pronation arcs were 20°–130° and 80°–80°, respectively,
which were similar between the groups. Rheumatoid arthritis and younger age were associated
with increased odds of wound complications and reoperation.
Conclusions
The rates of reoperation, wound complications, and HO were overall higher than those
previously reported; however, the study was underpowered to determine a difference
between early and delayed treatment.
Type of study/level of evidence
Therapeutic IV.
Key words
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Article info
Publication history
Published online: January 27, 2023
Accepted:
September 14,
2022
Received:
January 13,
2021
Publication stage
In Press Corrected ProofFootnotes
Dr Richard is a paid consultant for Acumed, LLC., Bioventus, DJO, Field Orthopaedics, Medartis, Depuy Synthes, and Restor3d. Dr Carofino is a consultant for DJO, Exactech, and Medacta. Dr Gaston is a paid consultant for Zimmer Biomet, Integra, DJO, and Restor3d; and receives royalties from Zimmer Biomet. No benefits in any form have been received or will be received by the other authors related directly or indirectly to the subject of this article.
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© 2022 by the American Society for Surgery of the Hand. All rights reserved.
