Elbow Arthroplasty for the Treatment of Distal Humerus Fractures

Abstract

Traditionally, elbow arthroplasty has been reserved for inflammatory arthritis, though more recently elbow replacement for fracture has become more common. The challenge of managing periarticular distal humeral fractures in older patients is reconstructing the elbow so as to allow early motion, in an effort to preserve function and prevent stiffness. The treatment options for distal humerus fractures in general include nonoperative management, open reduction and internal fixation, distal humeral hemiarthroplasty and total elbow arthroplasty. The common complications following nonoperative management include the development of an unstable pseudarthrosis, which prevents positioning the hand accurately in space, skin problems and nerve complaints. Open reduction and internal fixation (ORIF) must result in a stable construct to allow early range of movement and facilitate fracture healing. With new anatomical locking plates, the incidence of failed fixation is decreasing, but the development of symptomatic non-unions is still an issue. Finally, distal humeral hemiarthroplasty and total elbow replacement negate the need for stable fixation in otherwise poor-quality bone while allowing the patient to mobilize the elbow immediately and return more quickly to their activities of daily living. The main limitation with any form of arthroplasty is that, with time, aseptic loosening may lead to a need for revision surgery, while a well-fixed and united fracture generally has no need for further surgery.

In this chapter, we discuss the indications, techniques and outcomes of arthroplasty options in the treatment of distal humeral fractures in the older patient with poor bone quality.