Total elbow arthroplasty for distal humeral fractures: Indications, surgical approach, technical tips, and outcome
Section snippets
Indications for total elbow arthroplasty
As the original publication on this technique was in 1997, we felt it appropriate to revisit the indications for total elbow arthroplasty following distal humeral fractures. Our rational for this was that elbow surgeons had potentially gained a minimum of 10 years experience in the procedure and, therefore, may have widened their own indications. Furthermore, we felt that advances in prosthetic design and cementing techniques might have resulted in elbow surgeons being prepared to undertake
Preoperative assessment and planning
It is essential, preoperatively, to record the neurovascular status of the affected limb. Furthermore, the radiographs must be carefully evaluated in order to be certain that when surgery is undertaken the appropriate prostheses and equipment are available.
Surgical approach
The surgical approach that we have published15 and used since 1993 (video) involves a posterior skin incision that passes just to the medial side of the tip of the olecranon. We prefer this incision rather than the more traditional approach
Patients and methods
Between 1995 and 2002, we performed 26 consecutive total elbow arthroplasties in patients who had sustained comminuted distal humeral fractures. At review, 3 patients had died from unrelated causes, 2 had been lost to follow-up, and 1 patient could not be adequately assessed due to dementia. The remaining 20 patients were all clinically and radiologically reviewed. There were 4 men and 16 women with a mean age of 72 years (range, 62-92). The nondominant elbow was involved in 15 patients (70%).
Results
Each patient's outcome data is shown in the Table. At follow-up, 14 patients (70%) had no pain and 6 (30%) had mild pain not requiring analgesia. No patient had moderate or severe pain.
The mean flexion arc was 27°-125°. Mean pronation was 74° (range, 40°-90°) and mean supination was 77° (range, 40°-90°). Pronation and supination were measured as rotation of the hand, with the elbow flexed and stabilized at 90°.
The mean Mayo elbow performance score was 92 (range, 75-100). Thirteen patients had
Discussion
With the expected rise in the elderly population, it is estimated that there will be a significant increase in the number of distal humeral fractures by 2030.10 If these patients are to be well managed, early operative treatment is essential, thus allowing rapid rehabilitation and a return of functional elbow movement. The difficulty, however, is that, while fracture fixation is the treatment of choice, the presence of comminution and osteopenia makes this a demanding and difficult procedure in
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2019, Best Practice and Research: Clinical RheumatologyTotal Elbow Arthroplasty Gives Good Functional Outcome in Distal Humerus Fracture with Pre-existing Chronic Elbow Dislocation
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