A systematic review, and meta-analysis of pain outcomes following total elbow replacement and hemi-replacement for unreconstructible acute distal humerus fractures in adults

Background
Unreconstructible distal humerus fractures have been managed with total elbow replacement (TER), but there is increasing use of hemi-replacement (DHH). Pain has been identified as the most important outcome by patients. This study aims to systematically review the literature on reported pain outcomes in adult distal humerus fractures treated with TER or DHH.
Methods
Medline, Embase and Central were searched using OVID, from January 2000 to September 2023, for studies in adults undergoing DHH or TER for acute closed distal humerus fractures. The primary outcome was patient-rated pain measured on a numerical rating scale. A quantitative summary of reported outcomes was stratified by intervention type.
Results
Twenty-three studies met the inclusion criteria, including one published randomised controlled trial. Meta-analysis found a pooled average NRS pain for TER of 1.7/10 (95% CI 0.44 to 2.99) and 1.5/10 for DHH (95% CI 0.001 to 3.56). On a four-point Likert scale the pooled probability of no pain, mild pain, moderate pain, severe pain for TER was 0.75, 0.21, 0.02, 0.00 and for DHH was 0.76, 0.11, 0.12, 0.00.
Discussion
The available evidence does not enable comparison of pain outcomes between the interventions, which should be assessed in an appropriately powered randomised trial.