Background: The purpose of this study was to review the cases of
patients with a distal humeral fracture that was treated with a noncustom
total elbow arthroplasty. We hypothesized that, on the basis of the functional
and clinical outcome, total elbow replacement is a reliable option for the
treatment of elderly patients with a severe, comminuted fracture of the distal
part of the humerus.
Methods: We retrospectively reviewed forty-nine acute distal humeral
fractures in forty-eight patients who were treated with total elbow
arthroplasty as the primary option. The average age of the patients was
sixty-seven years. Forty-three fractures were followed for at least two years.
According to the AO classification, five fractures were type A, five were type
B, and thirty-three were type C. The average age of the forty-three patients
was sixty-nine years and the average duration of follow-up was seven years.
Fourteen patients died during the review period. Postoperative clinical
function was assessed with use of the Mayo elbow performance score, and
anteroposterior and lateral radiographs made at follow-up examinations were
Results: At the latest follow-up examination, the average flexion
arc was 24° (range, 0° to 75°) to 131° (range, 100° to
150°) and the Mayo elbow performance score averaged 93 of a possible 100
points. Heterotopic ossification was present to some extent in seven elbows,
with radiographic abutment noted in two. Thirty-two (65%) of the forty-nine
elbows had neither a complication nor any further surgery from the time of the
index arthroplasty to the most recent follow-up evaluation. Fourteen elbows
(29%) had a single complication, and most of them did not require further
surgery. Ten additional procedures, including five revision arthroplasties,
were required in nine elbows; five were related to soft tissue and five were
related to the implant or bone.
Conclusions: Complex distal humeral fractures should be assessed
primarily for the reliability with which they can be reconstructed with
osteosynthesis. When osteosynthesis is not considered to be feasible,
especially in patients who are physiologically older and place lower demands
on the joint, total elbow arthroplasty can be considered. This retrospective
review supports a recommendation for total elbow arthroplasty for the
treatment of an acute distal humeral fracture when strict inclusion criteria
Level of Evidence: Therapeutic study, Level IV (case
series [no, or historical, control group]). See Instructions to Authors for a
complete description of levels of evidence.