Fractured rheumatoid elbow: Treatment with Souter elbow arthroplasty - A clinical and radiologic midterm follow-up study

We report the results in 26 patients who had 32 preoperative fractures trea ted with Souter elbow arthroplasty. All were rheumatoid patients with a mea n disease duration of 29.7 years (range, 10 to 43). Six of the fractures we re of the olecranon and 26 of the distal humerus. The time interval between fracture and arthroplasty was 9 months (mean, range, 0 to 48). Fragments w ere not excised, and osteosynthesis was performed. The follow-up was 2.6 ye ars (mean; range, 0.5 to 8), when 20 of the fractures had united and 12 had not. K-wire fixation, either alone or in combination with cerclage or PDS suture, and bone grafting led to satisfactory results. Union was verified i n 14 of 17 cases created with this technique. There were no severe early co mplications. Six patients had late complications. In 3 cases, loosening of the humeral component was observed radiologically. One patient had a hemato genous deep infection 4 years after the operation, and 2 patients had avuls ion rupture of the triceps tendon. Fracture in the badly destroyed elbow ca n be more reasonably treated with an arthroplasty than with an attempt of o steosynthesis before arthroplasty. If excision of the fragments is avoided, original, or near original, anatomy of the elbow joint can be better resto red and acceptable outcome obtained with elbow arthroplasty.