title: Short-Term Complications of Distal Humerus Fractures in Elderly Patients: Open Reduction Internal Fixation Versus Total Elbow Arthroplasty.
abstract: BACKGROUND
  The purpose of this study was to evaluate 30-day postoperative complications of open reduction and internal fixation [ORIF] and total elbow arthroplasty [TEA] for the treatment of distal humerus fractures in elderly patients using a validated national database.
  
  
  METHODS
  Review of the National Surgical Quality Improvement Program (NSQIP) Database identified all elderly patients (>65 years) who underwent TEA or ORIF for the treatment of closed intra-articular distal humerus fractures from 2007 to 2013. Bivariate and multivariate analyses of risk factors for 30-day adverse events as defined by NSQIP between ORIF and TEA groups were assessed using preoperative and intraoperative variables.
  
  
  RESULTS
  Among the 176 patients with distal humerus fractures, there were 33 TEA and 143 ORIF. There was no difference in age, medical comorbidities, or functional status. Total elbow arthroplasty was associated with an increased odds of severe adverse event compared to ORIF (odds ratio = 1.57, P = .16), although it did not achieve statistical significance. Infection rate was 0.7% in ORIF and 0.0% in TEA (P = .99). Insulin-dependent diabetes and functional status were significant independent predictors of postoperative adverse events. Operative time (165 minutes vs 140 minutes, P = .06) and postoperative length of stay (3.6 days vs 2.3 days, P = 0.03) were longer for TEA compared to ORIF.
  
  
  CONCLUSIONS
  Open reduction and internal fixation and TEA have similar 30-day postoperative complications for the treatment of distal humerus fractures among elderly patients. Despite favorable trends for TEA in recent studies, additional clinical results are needed to understand complications and limitation of TEA.
  
  
  METHODS
  Level III, prognostic study.
authors.affiliation: Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Lovy
authors.affiliation: Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA.
authors.forename: Aakash
authors.initials: A
authors.lastname: Keswani
authors.affiliation: Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Koehler
authors.affiliation: Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA.
authors.forename: Jaehon
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Hausman
keywords: complications; open reduction and internal fixation; risk factors; total elbow arthroplasty; total elbow replacement