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Seniors' Health: Artificial joint beats plates and screws for elbow fractures

Canadian study shows seniors have better arm function when they undergo joint replacement surgery

Elderly people who shatter an elbow are better off getting the joint replaced rather than having the bone fragments fixed with plates and screws, a Canadian study has shown.

The study involved 40 seniors with a severe elbow fracture who were randomly assigned to joint replacement or fracture surgery. Over the next two years, elbow replacement patients were able to function better than those who had plates and screws.

“In the elbow replacement group they had much better range of motion and were able to do daily activities, such as doing their hair or putting on makeup, where they wouldn’t be able to do them with actually fixing the elbow,” says Dr. Christian Veillette, the study’s co-author and a clinical fellow in orthopedic surgery at the Mayo Clinic in Rochester, Minn., who worked on the study while at St. Michael’s Hospital in Toronto.

The study, he says, has “certainly changed our management of this patient group. … We’re much more likely to do an elbow replacement than we were in the past.” He adds, however, that plates and screws remain the gold standard for people younger than 65, in whom an artificial elbow would wear out too soon.

The elbow replacement consisted of metal components cemented to the end of the humerus (the bone of the upper arm) and the ulna (one of the forearm bones) and connected by a locking pin. The patients in the study all had fractures in which the end of the humerus was broken into pieces and displaced out of position. The typical participant was a woman in her late 70s with osteoporosis, or brittle bones.

The study was funded by the Orthopedic Trauma Association and by Zimmer Inc., the maker of the elbow replacement implant.

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