TOTAL ELBOW ARTHROPLASTY FOR TREATING DISTAL HUMERAL FRACTURES IN THE ELDERLY PATIENT

Abstract

Distal humeral fractures are difficult fractures to treat. In the elderly population the problems are compounded by gross comminution and osteoporosis. Concurrent presence of rheumatoid arthritis makes the problem more difficult. Open reduction and internal fixation of such fractures have been shown to give poor results. Total elbow replacement has been recommended as an alternative solution to this difficult problem. We present the results of a retrospective review of a small group of elderly patients who underwent total elbow arthroplasty in our unit for comminuted fractures of the distal end of the humerus.

We have followed up seven patients (seven elbows) with a mean age of 81. 7 years (range 74. 1 to 87. 8) at the time of injury. The presence of rheumatoid arthritis in three of them influenced the choice of treatment. All replacements were performed using the semiconstrained Coonrad-Morrey elbow replacement prosthesis. The duration of follow up at present is between two and four years. None of the patients have been lost to follow up.

At the latest follow up the mean arc of flexion was 20 to 130 degrees. 6 of the patients had no pain while 1 complained of mild pain. All elbows were stable. The Mayo Elbow Performance Score (MEPS) for five elbows was excellent, two scored good. The mean MEPS for all the elbows was 92/100. There were 2 cases of superficial wound infection and no cases of deep infection, ulnar nerve neuritis or component failure.

These results suggest that a semiconstrained total elbow replacement has a role to play in the treatment of carefully selected distal humeral fractures, which cannot be treated by internal fixation due to extensive intraarticular comminution and gross osteopenia. Although these are short-term follow up results they are encouraging outcomes for treatment of one of the most challenging fractures.