Department of Upper Limb Surgery, Insitututo Kaplan, Barcelona, Spain

Department of Orthopaedic and Trauma Surgey, Hospital Del Mar, Barcelona, Spain

Department of Orthopaedic Surgery, Hospital Esperit Sant, Santa Coloma de Gramanet, Spain

Department of Orthopaedic Surgery, Hospital Valle Del Nalón, Langreo, Spain

Purpose: The aim of this study was to review the results of linked total elbow arthroplasty as treatment of distal humerus fractures and nonunions.

Material and Methods: We retrospectively reviewed 21 patients with AO type C acute distal humerus fractures treated primarily with elbow replacement (17 cases) or dysfunctional nonunions treated with arthroplasty as a salvage procedure (6 cases). The average age at the time of surgery was 76 years and the mean follow up was 52 months (24 to 91 months). Clinical evaluation was performed with the Mayo Elbow Performance Score (MEPS) and the DASH score. Grade of patient satisfaction and complications were also recorded. AP and lateral radiographs made at the latest follow-up examination were reviewed.

Results: At the latest follow-up examination, the average flexion arc was from 24º (range, 0º to 90º) to 119º (range, 30º to 150º), and the MEPS averaged 71 points. The average DASH score was 48. Only eleven (52%) of the twenty-one elbows had neither a complication nor any further surgery from the time of the arthroplasty. Four patients (19%) had an infection which was resolved with debridement and antibiotics in two cases and required removal of the implant in the other two. Eight patients (38%) had symptoms related to ulnar nerve irritation. One patient had symptomatic humeral component loosening but rejected further surgery. Overall, according to the MEPS, twelve patients (57%) had a satisfactory result and sixteen patients (76%) were subjectively satisfied with the result.

Conclusion: Our study suggests that, although elbow replacement can be an option when osteosynthesis is not feasible in complex distal humeral fractures and nonunions, the rate of complications and unsatisfactory results may be higher than previously reported.