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Management of Acute Distal Humeral Fractures in Patients with Rheumatoid Arthritis

A Case Series

¹ Department of Orthopaedics, University of Zurich, Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland. E-mail address: bernhard.jost{at}balgrist.ch
² Department of Orthopedics, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
Investigation performed at the Department of Orthopedics, Mayo Clinic, Rochester, Minnesota

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Methods: Between 1982 and 2002, an acute distal humeral fracture was treated surgically in sixteen elbows in fourteen patients with rheumatoid arthritis, and the results were retrospectively reviewed at a minimum of twenty-four months postoperatively. Six elbows were treated with open reduction and internal fixation (Group 1) and ten elbows, with primary total elbow arthroplasty (Group 2). Postoperatively, the elbows were examined with standard radiographs, and the clinical outcome was assessed with the Mayo Elbow Performance Score (MEPS).

Results: Six patients (six elbows) died before the time of the study, but they had been followed for more than twenty-four months and therefore were included in the series. The eight patients (ten elbows) who were still alive were examined. The mean duration of follow-up was forty-nine months in Group 1 and sixty-six months in Group 2. The MEPS averaged 93 points in Group 1 and 96 points in Group 2. Radiographically, all fractures had healed uneventfully in Group 1 and no prosthesis was loose in Group 2. We could not identify any difference between Groups 1 and 2 with respect to patient age, fracture type, or extent of the rheumatoid arthritis.

Conclusions: Distal humeral fractures in patients with rheumatoid arthritis can be treated successfully with immediate open reduction and internal fixation or with total elbow arthroplasty. Our data suggest that open reduction and internal fixation can be successful when there is mild arthritic involvement. We favor total elbow arthroplasty for patients with severe articular involvement.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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