We conducted a prospective randomised controlled trial to compare functional outcomes, complications and reoperation rates in elderly patients with displaced intra-articular distal humerus fractures treated with open reduction internal fixation (ORIF) or primary semi-constrained total elbow arthroplasty (TEA).

Twenty-one patients were randomised to each treatment group. Two patients died prior to follow-up and were excluded from the study. Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) scores were collected at six weeks, three months, six months, twelve months and two years. Complication type, duration, management, and treatment requiring reoperation were recorded.

Five patients randomised to ORIF were converted to TEA intraoperatively because of extensive comminution and inability to obtain fixation stable enough to allow early ROM. This resulted in fifteen patients (three male, twelve female) with an average age of seventy-seven years in the ORIF group and twenty-five patients (two male, twenty-three female) with an average age of seventy-eight in the TEA group. MEPS was significantly improved at three months (82 vs 65, p=0.01), six months (86 vs 66, p=0.003), twelve months (87 vs 72, p=0.03) and two years (86 vs 73, p=0.04) in patients with TEA compared with ORIF. DASH scores showed a significant improvement for TEA compared with ORIF between six weeks (43 vs 77, p=0.02) and six months (31 vs 50, p=0.01) but not at twelve months (32 vs 47, p=0.1) and two years (34 vs 38, p=0.6). Reoperation rates for TEA (3/25) and ORIF (4/15) were not statistically different (p=0.2).

TEA for the treatment of comminuted intra-articular distal humeral fractures provides improved functional outcome compared with ORIF.