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Open reduction and internal fixation compared with primary total elbow arthroplasty for displaced intra-articular fractures of the distal humerus in the elderly: a systematic review of the literature

The optimal management of complex intra-articular fractures in the elderly is controversial. We evaluated the best available evidence comparing open reduction and internal fixation with total elbow arthroplasty to assist in clinical decision making for treatment of displaced intra-articular fractures of the distal humerus in elderly patients. We systematically reviewed the effect of alternative methods of treatment of displaced intra-articular distal humeral fractures on validated functional outcome scores and secondary outcomes of further surgery and pain. We identified 59 citations: 39 from MEDLINE, 20 from EMBASE and 0 from the Cochrane Central register of controlled trials. Only two studies proved eligible. All studies compared primary total elbow arthroplasty with open reduction and internal fixation for treatment of acute displaced intra-articular distal humeral fractures. From the available evidence, functional outcome as recorded by the Mayo Elbow Performance Score was better in patients who underwent total elbow arthroplasty compared with internal fixation. In addition, there was a higher re-operation rate in patients who underwent internal fixation. Ideally a large, randomized, controlled prospective study would help in fully ascertaining the most favorable treatment method of these complex and debilitating injuries.