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Technique Spotlight: Total Elbow Arthroplasty for Distal Humerus Fracture


Introduction

Articular fractures of the distal humerus are treated most successfully with operative intervention in order to restore function. Despite advances in plating constructs, these fractures can be difficult to fix and failures can result in a high reoperation rate. Therefore in unreconstructable distal humerus fractures, total elbow arthroplasty (TEA) has arisen as a viable treatment option.

Indications

Unreconstructable distal humeral fractures—those fractures in which open reduction internal fixation (ORIF) is not possible due to the size of the fragments, severe comminution, and/or poor bone quality where screw purchase is not possible ( Fig. 38.1A–D ).

Fig. 38.1, (A) Lateral oblique, (B) anteroposterior, and (C) posterior views of a three-dimensional computed tomography reconstruction shows an unreconstructable distal humerus fractures with multiple comminuted fragments, a complete articular shear (arrow) fracture with little subchondral bone, and supracondylar comminution of both the medial and lateral columns (asterisk) . (D) The intraoperative picture of the multiple comminuted fracture fragments unable to reliably receive fixation.

Relative Indications

  • Osteoporotic bone stock in an elderly patient

  • Low-demand patient

  • Distal humeral articular fracture in rheumatoid or preexisting arthrosis

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