Total elbow arthroplasty has become increasingly popular for the treatment of distal humerus fractures in elderly patients with poor bone quality, comminution, and/or pre-existent elbow abnormalities. The procedure is performed without violating the extensor mechanism; the fractured fragments are exposed and resected on both sides of the triceps, and the components can be implanted through the same exposure. Early outcomes are satisfactory in most elbows and compare favorably with internal fixation in this same group of elderly patients. Advances in elbow arthroplasty for fractures will likely combine refinement of the indications and development of implants with lower rates of failure.
Key points
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Total elbow arthroplasty provides a successful early outcome for most elderly patients with comminuted distal humerus fractures.
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The procedure typically involves resection of the fractured fragments, which allows implantation of the components without violation of the extensor mechanism.
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Life-long activity restrictions are recommended after elbow arthroplasty to minimize implant mechanical failure.
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Direct comparisons between internal fixation and arthroplasty for selected elderly patients with distal humerus fractures have shown better outcomes with arthroplasty.
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Mid-term and long-term studies do report several failures secondary to infection, loosening, and periprosthetic fractures.
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