Traditionally, elbow arthroplasty has been reserved for inflammatory arthritis, though more recently elbow replacement for fracture has become more common. The challenge of managing periarticular distal humeral fractures in older patients is reconstructing the elbow so as to allow early motion, in an effort to preserve function and prevent stiffness. The treatment options for distal humerus fractures in general include nonoperative management, open reduction and internal fixation, distal humeral hemiarthroplasty and total elbow arthroplasty. The common complications following nonoperative management include the development of an unstable pseudarthrosis, which prevents positioning the hand accurately in space, skin problems and nerve complaints. Open reduction and internal fixation (ORIF) must result in a stable construct to allow early range of movement and facilitate fracture healing. With new anatomical locking plates, the incidence of failed fixation is decreasing, but the development of symptomatic non-unions is still an issue. Finally, distal humeral hemiarthroplasty and total elbow replacement negate the need for stable fixation in otherwise poor-quality bone while allowing the patient to mobilize the elbow immediately and return more quickly to their activities of daily living. The main limitation with any form of arthroplasty is that, with time, aseptic loosening may lead to a need for revision surgery, while a well-fixed and united fracture generally has no need for further surgery.
In this chapter, we discuss the indications, techniques and outcomes of arthroplasty options in the treatment of distal humeral fractures in the older patient with poor bone quality.
This is a preview of subscription content, log in to check access.
Rajaee SS, Lin CA, Moon CN. Primary total elbow arthroplasty for distal humeral fractures in elderly patients: a nationwide analysis. J Should Elbow Surg. 2016;25:1854–60.CrossRefGoogle Scholar
Kamineni S, Morrey BF. Distal humeral fractures treated with noncustom total elbow replacement. J Bone Joint Surg Am. 2004;86:940–7.CrossRefPubMedGoogle Scholar
Cobb TK, Morrey BF. Total elbow arthroplasty as primary treatment for distal humeral fractures in elderly patients. JBJS. 1997;79:826–32.CrossRefGoogle Scholar
Huang TL, Chiu FY, Chuang TY, Chen TH. The results of open reduction and internal fixation in elderly patients with severe fractures of the distal humerus: a critical analysis of the results. J Trauma. 2005;58:62–9.CrossRefPubMedGoogle Scholar
Korner J, Lill H, Muller LP, Hessmann M, Kopf K, Goldhahn J, et al. Distal humerus fractures in elderly patients: results after open reduction and internal fixation. Osteoporos Int. 2005;16:S73–9.CrossRefPubMedGoogle Scholar
Srinivasan K, Agarwal M, Matthews SJ, Giannoudis PV. Fractures of the distal humerus in the elderly: is internal fixation the treatment of choice? Clin Orthop Relat Res. 2005;434:222–30.CrossRefGoogle Scholar
McKee MD, Wilson TL, Winston L, Schemitsch EH, Richards RR. Functional outcome following surgical treatment of intra-articular distal humeral fractures through a posterior approach. J Bone Joint Surg Am. 2000;82:1701–7.CrossRefPubMedGoogle Scholar
Sodergard J, Sandelin J, Bostman O. Postoperative complications of distal humeral fractures. 27/96 adults followed up for 6 (2–10) years. Acta Orthop Scand. 1992;63:85–9.CrossRefPubMedGoogle Scholar
Prasad N, Dent C. Outcome of total elbow replacement for distal humeral fractures in the elderly: a comparison of primary surgery and surgery after failed internal fixation or conservative treatment. J Bone Joint Surg. 2008;90:343–8.CrossRefGoogle Scholar
Korner J, Lill H, Muller LP, et al. Results after open reduction and internal fixation. Osteoporsis Int. 2005;16:S73–9.CrossRefGoogle Scholar
Dunn J, Kusnezov N, Pirela-Cruz M. Distal humeral hemiarthroplasty: indications, results, and complications. A systematic review. Hand. 2014;9(4):406–12.CrossRefPubMedGoogle Scholar
Ibrahim EF, Rashid A, Thomas MJ. Linked semiconstrained and unlinked total elbow replacement in juvenile idiopathic arthritis: a case comparison series with mean 11.7-year follow-up. Should Elbow Surg. 2017;26:305–13.CrossRefGoogle Scholar
Ali A, Shahane S, Stanley D. Total elbow arthroplasty for distal humeral fractures: indications, surgical approach, technical tips, and outcome. J Shoulder Elb Surg. 2010;19:53–8.CrossRefGoogle Scholar
Espiga X, Antuna SA, Ferreres A. Linked total elbow arthroplasty as treatment of distal humerus nonunions in patients older than 70 years. Acta Orthop Belg. 2011;77(3):304–10.PubMedGoogle Scholar
Prasad N, Ali A, Stanley D. Total elbow arthroplasty for non-rheumatoid patients with a fracture of the distal humerus: a minimum ten-year follow-up. Bone Joint J. 2016;98:381–6.CrossRefPubMedGoogle Scholar
Linn MS, Gardner MJ, McAndrew CM, Gallagher B, Ricci WM. Is primary total elbow arthroplasty safe for the treatment of open intra-articular distal humerus fractures? Injury. 2014;45:1747–51.Google Scholar
Burkhart KJ, Nijs S, Mattyasovszky SG, Wouters R, Gruszka D, Nowak TE, et al. Distal humerus hemiarthroplasty of the elbow for comminuted distal humeral fractures in the elderly patient. J Trauma. 2011;71:635–42.CrossRefPubMedGoogle Scholar
Chalidis B, Dimitriou C, Papdopoulos P, Petsatodis G, Giannoudis PV. Total elbow arthroplasty for the treatment of insufficient distal humeral fractures. A retrospective clinical study and review of the literature. Injury. 2009;40:582–90.CrossRefPubMedGoogle Scholar
Goldberg SH, Urban RM, Jacobs JJ. Modes of wear after semiconstrained total elbow arthroplasty. J Bone Joint Surg Am. 2008;90:609–19.CrossRefPubMedGoogle Scholar