Total elbow arthroplasty for distal humeral fractures: Indications, surgical approach, technical tips, and outcome

https://doi.org/10.1016/j.jse.2009.12.013Get rights and content

Background

Twenty-six consecutive total elbow arthroplasties were performed for comminuted distal humeral fractures between 1995 and 2002. At review, 3 patients had died from unrelated causes, 2 had been lost to follow-up, and 1 could not be assessed due to dementia. The mean age of the remaining 20 patients was 72 years (range, 62-92). There were 4 men and 16 women.

Method

The mean follow-up was 63.2 months (range, 36-108). The mean Mayo Elbow Performance Score was 92 (75-100) with a mean flexion arc of 27°-125°.

Result

One patient had a postoperative superficial infection, which required a course of antibiotic therapy, and 1 patient who had a radial nerve neuropraxia recovered spontaneously after 6 weeks. Radiographs showed 19 implants were well fixed with no evidence of loosening, while 1 patient had a nonprogressive radio-lucent line on the ulna side of the prosthesis. Additionally, 2 patients developed heterotopic ossification without identifying pre-disposing factors.

Conclusion

Total elbow arthroplasty for distal humeral fractures in elderly patients without inflammatory arthritis can be expected to five good results at a mean follow-up of 5 years.

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

References (16)

  • P.S. Ray et al.

    Total elbow arthroplasty as primary treatment for distal humeral fractures in elderly patients

    Injury

    (2000)
  • A. Ali et al.

    Revision surgery for nonunion after early failure of fixation of fractures of the distal humerus

    J Bone Joint Surg Br

    (2005)
  • E.V. Cheung et al.

    Total elbow prosthesis loosening caused by ulnar component pistoning

    J Bone Joint Surg

    (2007)
  • T.K. Cobb et al.

    Total elbow arthroplasty as primary treatment for distal humeral fractures in elderly patients

    J Bone Joint Surg Am

    (1997)
  • M.A. Frankle et al.

    A comparison of open reduction and internal fixation and primary total elbow arthroplasty in the treatment of intra-articular distal humeral fractures in women older than 65

    J Orthop Trauma

    (2003)
  • R. Gambirasio et al.

    Total elbow replacement for complex fractures of the distal humerus: an option for the elderly patient

    J Bone Joint Surg Br

    (2001)
  • J.A. Garcia et al.

    Complex fractures of the distal humerus in the elderly: The role of total elbow replacement as primary treatment

    J Bone Joint Surg Br

    (2002)
  • N. Gschwend

    Our operative approach to the elbow joint

    Arch Orthop Traumat Surg

    (1981)
There are more references available in the full text version of this article.

Cited by (72)

  • Management of Geriatric Elbow Injury

    2021, Orthopedic Clinics of North America
  • Total Elbow Arthroplasty Gives Good Functional Outcome in Distal Humerus Fracture with Pre-existing Chronic Elbow Dislocation

    2018, Journal of Orthopaedics, Trauma and Rehabilitation
    Citation Excerpt :

    Total elbow arthroplasty (TEA) is increasingly and commonly used for the primary treatment of selected distal humerus fractures in elderly patients. TEA is also indicated when there is pathological fracture, degenerative elbow disease, post-traumatic arthritis, and nonunion of the distal humerus.1 Chronic elbow dislocation may be another pre-existing condition of the elbow that favours TEA for distal humerus fracture.

View all citing articles on Scopus
View full text