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Should be performed through an anterolateral approach
1%
11/1261
Stiffness is the most common postoperative complication
12%
152/1261
Plates should be placed in parallel
12/1261
Patients are typically restricted to lifting no more than 5-10 lbs in the affected extremity for life after surgery
83%
1052/1261
ORIF of the radial head or replacement is required for construct stability
2%
24/1261
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Total elbow arthroplasty (TEA) is the treatment of choice for an elderly low demand patient with a comminuted intraarticular distal humerus fracture. Postoperatively, a lifting restriction of 5-10 pounds is needed to prevent the risk of implant loosening. Intraarticular distal humerus fractures are relatively common injures and occur most commonly in the setting of high energy trauma in younger males or low energy falls in elderly females. TEA is a well-recognized method for the treatment of complex distal humerus fractures that result in improved ROM, improved patient-reported outcomes and decreased rates of revision surgery, especially for elderly, low demand females. Postoperatively, patients are typically immobilized and must follow a lifelong weightlifting restriction of 5-10 pounds to prevent loosening of the implants. Varecka et al. reviewed distal humerus fracture treatment in the elderly population. They reported that total elbow arthroplasty provides improved early functional outcomes following distal humerus fractures, but devastating complications can also occur. They concluded that with modern technology and experienced specialist, predictable outcomes and return to function can be expected, even in the elderly, following these injuries. Choo et al. reviewed the current options for total elbow arthroplasty. They reported there has been considerable improvement in implant designs over the last 3 decades including unlinked, linked semi-constrained and convertible devices. Furthermore, they outlined the previous good results in the RA population has led to expanded indications for acute and posttraumatic conditions. They concluded that improvements in implant fixation, polyethylene design, and component implantation will determine the future success of TEA. Galano et al review the current treatment strategies for bicolumnar distal humerus fractures. They report that with the elderly osteoporotic patient, the distal humerus is often severely comminuted, making open reduction internal fixation impossible. They conclude that TEA in these patients is a good option with excellent results, however, patients must understand the lifetime lifting restriction of 5-10 pounds that are required following this procedure. Figure A is the AP radiograph of the elbow demonstrating a comminuted, intraarticular distal humerus fracture in an osteoporotic patient. Incorrect Answers: Answer 1: The anterolateral approach is used for humeral shaft fractures, not distal humerus fractures. Answer 2 and 3: Stiffness is the most common complication following ORIF, which is not the best treatment option for this comminuted distal humerus fracture in an elderly female with RA. Answer 5: The radial head is not required for stability in linked TEA designs, like those used in the setting of RA. Often times, the radial head is resected in patients with RA due to mechanical symptoms or pain.
3.7
(6)
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