Linked total elbow arthroplasty as treatment of distal humerus fractures

Treatment of distal humerus fractures may be challenging, especially in the elderly patient. Total elbow replacement has been proposed as an option in selected patients. We present the results of a linked elbow replacement in 16 patients with a comminuted fracture of the distal humerus which was not considered amenable to reliable open reduction and internal fixation. At a mean follow-up of 57 months, average range of motion was from 28 degrees to 117 degrees of flexion-extension. Five patients with moderate to severe pain (31%) were not satisfied with the results of the operation. Three patients had an infection which resulted in implant removal in one patient. Eight patients had symptoms of sensory ulnar nerve neuropathy. Our results show that elbow replacement may be an optimal solution for highly comminuted osteoporotic fractures, if there are no associated complications. However, the rate of significant and minor complications such as infection or postoperative ulnar nerve symptoms is probably higher than reported. Appropriate selection of ideal candidates for this procedure and meticulous surgical technique are of paramount importance in reducing the risk of complications.