title: Primary total elbow arthroplasty for distal humeral fractures in elderly patients: a nationwide analysis.
abstract: BACKGROUND
  Displaced intra-articular distal humeral fractures are a challenging injury in elderly patients. High rates of complications have led to the increasing use of total elbow arthroplasty (TEA) for primary treatment. This study presents US nationwide trends in primary TEA for distal humeral fractures in elderly patients (65 years and older) from 2002 to 2012. We hypothesized that there was an increase in the rate of TEA utilization.
  
  
  METHODS
  Data were obtained from the Nationwide Inpatient Sample for the years 2002 to 2012. All inpatients 65 years and older with distal humeral fractures were identified and were divided into 2 subgroups based on the operation they received: (1) TEA and (2) open reduction-internal fixation (ORIF).
  
  
  RESULTS
  Between 2002 and 2012, the annual frequency of TEA for elderly patients with distal humeral fractures increased 2.6-fold, with 147 patients in 2002 and 385 in 2012. In 2012, TEA was performed in 13% of operatively treated distal humeral fractures compared with only 5.1% in 2002 (P < .05). Mean hospital charges increased significantly for both the ORIF and TEA groups from 2002 to 2012. The average hospital charge for TEA in 2012 was $85,365, which was $16,358 higher than that for patients who underwent ORIF (P < .05).
  
  
  CONCLUSIONS
  The national rate of primary TEA for the acute management of distal humeral fractures in elderly patients has increased significantly over the past 10 years. Given the significant complexity, long-term restrictions, and risks associated with TEA, this increasing trend should be analyzed closely.
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: Sean.Rajaee@cshs.org.
authors.forename: Sean S
authors.initials: SS
authors.lastname: Rajaee
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Lin
authors.affiliation: Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Charles N
authors.initials: CN
authors.lastname: Moon
mesh_terms: D000368:Aged; D057929:Arthroplasty, Replacement, Elbow / Q000706:statistics & numerical data* / Q000639:trends; D004551:Elbow Joint / Q000601:surgery; D005260:Female; D005593:Fracture Fixation, Internal / Q000706:statistics & numerical data / Q000639:trends; D019538:Health Care Surveys; D006742:Hospital Bed Capacity; D017722:Hospital Charges / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D008297:Male; D019035:Rural Health Services / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D019037:Urban Health Services / Q000706:statistics & numerical data
keywords: HCUP; Nationwide Inpatient Sample; Total elbow arthroplasty; distal humeral fractures; elbow arthroplasty; elbow fractures