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
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
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
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 are observed.