Elbow arthroplasty in coronal shear fractures in the elderly: series of cases and review of classification systems

BACKGROUND: A large spectrum of associated injuries has been described and affect up to 36.8% of patients with distal humeral coronal plane shear fractures (DHCPSFs). Among these, lateral and medial epicondyle fractures are often present in the elderly. The purpose of this retrospective case-series study was to analyze the outcomes of acute implant of partial or total elbow replacement for DHCPSFs in elderly patients and to review all the issues related to the classification systems. METHODS: Between 2015 and 2019, eight patients aged more than 65 years with DHCPSF were surgically treated with partial or total elbow arthroplasty. All patients had comminuted DHCPSFs with lateral epicondyle fracture or both lateral and medial epicondyle fracture. At final follow-up (mean 35.87 months), the clinical evaluation included analysis of range of motion (ROM) and assessment of Mayo Elbow Performance Index (MEPI). Radiographic assessment. including presence of periprostehetic radiolucency and heterotopic ossification, was also performed. RESULTS: The average ROM was 72.5 degrees, with an average of 102.5 degrees of maximum flexion and an average extension lag of 30 degrees. The average MEPI score was 72.5 points with 3 excellent results, 1 good, 1 fair and 3 poor results. CONCLUSIONS: Most of commonly used classification systems for DHCPSFs do not contemplate the presence of associated lesions. In younger population associate lesions do not change the type of treatment, that is open reduction and internal fixation. In the elderly the associated injuries could lead to another type of treatment, i.e. partial or total elbow replacement. Classification systems should be revised, as may not help the surgeon in the choice of best treatment in the elderly. Indeed, in our series, those patients who had undergone to partial/total elbow arthroplasty with preoperative decision had better results than patients with intraoperative conversion in terms of MEPI score, maximum flexion and extension lag.