TOTAL ELBOW ARTHROPLASTY AS PRIMARY-TREATMENT FOR DISTAL HUMERAL FRACTURES IN ELDERLY PATIENTS

We retrospectively reviewed the results of primary total elbow arthrop lasty for the treatment of an acute fracture of the distal aspect of t he humerus in twenty consecutive patients (twenty-one elbows) who had a mean age of seventy-two years (range, forty-eight to ninety-two year s) at the time of the injury. The patients were managed between Novemb er 1982 and October 1992, The presence of rheumatoid arthritis in nine patients (ten elbows) influenced the choice of treatment, The mean in terval between the injury and the total elbow arthroplasty was seven d ays (range, one to twenty-five days), The mean duration of postoperati ve hospitalization was seven days (range, four to thirteen days), The mean duration of follow-up was 3.3 years (range, three months to 10.5 years), All patients were followed for a minimum of two years or until the time of death; the duration of follow-up was less than two years for three patients who died, None of the patients were lost to follow- up, Twenty implants were intact at the latest follow-up examination, O ne patient had a revision total elbow arthroplasty twenty months after the index procedure because of a fracture of the ulnar component sust ained in a fall on the outstretched arm, On the basis of the Mayo elbo w performance score, fifteen elbows had an excellent result and five h ad a good result; there were inadequate data for one elbow There were no fair or poor results, The mean are of flexion was 25 to 130 degrees , There was no evidence of loosening on the radiographs. Postoperative complications included fracture of the ulnar component in one patient , ulnar neurapraxia in three, and reflex sympathetic dystrophy in one, The results suggest that total elbow arthroplasty can be an alternati ve form of treatment of a severely comminuted fracture of the distal a spect of the humerus in older patients even in the presence of rheumat oid arthritis. This procedure is not an alternative to osteosynthesis in younger patients.