Original article
Unlinked elbow arthroplasty as primary treatment for fractures of the distal humerus

https://doi.org/10.1016/j.jse.2007.06.011Get rights and content

This study reviews our experience with primary total elbow arthroplasty in the management of acute distal humeral fractures by use of the iBP unlinked elbow prosthesis. We followed up 9 elbows in 9 patients (including 2 with rheumatoid arthritis), with a mean age of 73 years, for a mean of 3.5 years. Functional outcome was assessed with the Mayo Elbow Performance Score and the recently developed Liverpool Elbow Score. Clinical examination and radiologic assessment were performed by an independent surgeon. All elbows were stable at the latest follow-up examination, all patients were able to perform daily activities, and pain relief was satisfactory. The median value for the Mayo Elbow Performance Score was 95 (range, 65-100). This is the first report of the use of an unlinked prosthesis for the treatment of distal humeral fractures. Our results show that this method of treatment provides a reliable and effective way of dealing with these very difficult fractures when internal fixation is not a viable option.

Section snippets

Materials and methods

From July 1999 to May 2002, 13 iBP (Biomet UK, Bridgent, England) unlinked elbow arthroplasties were performed in 13 patients with acute fractures of the distal humerus. All elbows were operated on by a single surgeon. The principal indication was poor bone quality, combined with fracture comminution, that would make successful internal fixation extremely unlikely. Of the patients, 4 died of causes unrelated to the operation, leaving 9 elbows in the study. The remaining 9 patients comprised 8

Results

The 4 deceased patients had regular clinical and radiologic follow-up, and according to our review of the medical records, no complications were recorded and the patients were satisfied with the daily function of their elbows. Of the 9 remaining patients, 1 (patient 7) was not available for the final clinical assessment; however, he had completed 4 years of follow-up without clinical or radiologic complications and had a satisfactory subjective result (Table II). Of the remaining 8 elbows, all

Discussion

There is little information currently on the use of elbow arthroplasty in acute elbow trauma. There are a few reports on the management of acute fractures of the distal humerus with elbow replacement by use of the Coonrad-Morrey linked prosthesis in low-demand elderly patients with comminution and osteopenia.4, 5, 7 These studies have confirmed that primary total elbow arthroplasty is an acceptable option for the management of these difficult fractures.8, 12, 21 More recently, the use of a

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      Since then there has been an increasing number of publications advocating TER as the primary treatment for comminuted fractures of the distal humerus in the elderly. Whereas in the decade prior to 2005, during which TER began to be used as the primary treatment for comminuted fractures of the distal humerus in the elderly, there were only 4 publications reporting the results [6–9] in the subsequent decade to date there have been 11 publications [10–20]. All of these publications reported overall good results and a relatively low incidence of complications with one exception [18].

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