Abstract
Introduction
Primary Total Elbow Replacement (TER) is gaining popularity as a primary treatment option for osteoporotic fractures of the elbow, particularly in patients with low demand. The aim of this study was to assess the clinical and functional efficacy of TER as a primary treatment for comminuted distal humerus fractures in the elderly.
Methods
We retrospectively reviewed twenty-three patients (22 females and 1 male) who were treated with primary total elbow replacement for complex, intra-articular fractures of the distal humerus in the elderly between March 2000 and January 2010. The average age of the patients was seventy-five years (ranging from 66 to 94 years). Postoperative elbow function was assessed using the Mayo Elbow Performance Score. The radiological assessment was performed using antero-posterior and lateral radiographs done at follow-up appointments.
Results
The average duration of follow up was 6 years. Overall, the mean Mayo elbow performance score was 93 points out of 100. The arc of flexion averaged at 94.3degrees. One patient developed blisters at her arm postoperatively but resolved with dressings. Two patients (8.6%) had mild pain at two years post surgery but there was no evidence of implant loosening or evidence of infection. One patient developed superficial infection which was treated with antibiotics. Nineteen (82%) of the twenty-three elbows had neither a complication nor further surgery from the time of TER to the recent follow up.
Conclusions
Our review suggests that total elbow replacement as a primary treatment for comminuted distal humerus fractures in the elderly can give good to excellent results both in the short and the long term basis. When osteosynthesis is not a feasible option, especially in older patients who place lower demands on the joint, total elbow replacement can be considered a the primary treatment.
