Review Question - QID 214826

This patient was treated with a total elbow arthroplasty (TEA). In the early postoperative period, active elbow extension should be restricted to prevent triceps insufficiency.

TEA is an increasingly used motion-preserving modality for the treatment of many debilitating elbow pathologies. Primary indications include rheumatoid arthritis, post-traumatic arthritis, and intra-articular distal humeral fractures in the elderly with poor bony quality. Semiconstrained implants have the best longevity and most optimal functional outcomes. Several approaches have been described including triceps-reflecting, triceps-splitting, and triceps-sparing. In the early postoperative period, active elbow extension should be restricted to avoid early complications of triceps insufficiency and wound dehiscence.

Choo et al. reviewed TEA. They report that complications following TEA include infection, aseptic loosening, polyethylene wear, periprosthetic fracture, triceps insufficiency, wound breakdown, and ulnar nerve injury. They concluded that improvement in implant fixation, polyethylene design, component implantation, and pathology-specific implants will determine the future success of TEA.

Lami et al. reviewed TEA utilization in distal humerus fracture in elderly osteoporotic patients. They report a mean extension deficit of 22°, and a mean flexion 125°, with an overall complication rate of 9.5%. They concluded that TEA proved reliable in comminuted distal humerus fracture in elderly patients, and functional results were comparable to those in the literature, and the complications rate were lower.

Illustration A is a drawing of the posterior triceps reflecting approach to the elbow.

Incorrect answers:
Answers 1,3-5: These motions are tolerated in the early postoperative period. Active elbow extension should be restricted to avoid early complications of triceps insufficiency.