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Total Elbow Arthroplasty for the Treatment of Distal Humerus Nonunions

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Arthroplasty for the Treatment of Fractures in the Older Patient

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Abstract

Distal humerus fractures develop into nonunions in up to 20% of cases. The clinical pattern is characterized by pain, instability and loss of upper extremity function. The treatment is challenging and is influenced by the presence of residual degenerated articular surfaces, poor bone quality, joint contracture, dystrophic soft tissues and implants placed previously as well as small bone fragments.

In young demanding patients, osteosynthesis revision, with bone autograft or allograft in cases of bone loss, and take down of joint contractures are the first choice of treatment. When this procedure is not possible, salvage techniques such as interposition arthroplasty are valid alternatives. In selected older low-demand patients, where fixation is not possible, total elbow arthroplasty is a good option of treatment. Preoperative assessment of these patients must include exclusion of underlying infection which, if present, would require a different therapeutic approach. Amongst the variety of implant types available, linked implants are most frequently utilized because capsular and ligamentous insufficiency is frequently associated with nonunions.

The surgical technique is difficult, with a steep learning curve. Post-operative rehabilitation and lifetime restriction in terms of use and lifting are important for satisfying outcomes and long-lasting survival of the implants.

Outcomes reported in the literature are satisfying, both in terms of pain relief and in recovery of function, although a considerable rate of complications and implant revision has been reported.

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Acknowledgements

Authors want to thank Dr Silvio Tocco for language support. Authors also want to thank Roberto Rotini, MD, and Maurizio Corradi, MD, for the teaching regarding surgery of the upper limb.

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Authors and Affiliations

  1. Orthopedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy

    Davide Aliani & Francesco Pogliacomi

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  1. Davide Aliani
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  2. Francesco Pogliacomi
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Editors and Affiliations

  1. BayCare Health System, Lutz, FL, USA

    Joseph Borrelli Jr.

  2. Hughston Clinic, Indianapolis, IN, USA

    Jeffrey O. Anglen

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Aliani, D., Pogliacomi, F. (2018). Total Elbow Arthroplasty for the Treatment of Distal Humerus Nonunions. In: Borrelli Jr., J., Anglen, J. (eds) Arthroplasty for the Treatment of Fractures in the Older Patient. Springer, Cham. https://doi.org/10.1007/978-3-319-94202-5_14

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  • DOI: https://doi.org/10.1007/978-3-319-94202-5_14

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