Review Question - QID 215448

Implant loosening is a complication that is specific to Total Elbow Arthroplasty (TEA), which is the proposed procedure in this case, and not Open Reduction Internal Fixation (ORIF). Non-union is not a complication of TEA.

McKee et al prospectively randomized patients over the age of 65 with distal humerus fractures to ORIF vs. TEA. TEA had higher Mayo Elbow Performance Scores at all time points, including at 2 years follow-up. With TEA, operative time was 32 minutes less and motion was superior (107-97 degrees). Reoperation rates were similar.

Sela and Baratz review the treatment of distal humerus fractures in the elderly population. Fractures can be treated non-surgically with 4-6 weeks of immobilization in patients with severe medical comorbidities. However, the two primary treatments are TEA and ORIF. ORIF can be technically challenging when the joint surface is comminuted and carries a risk of non-union. TEA is an excellent option in the setting of a comminuted fracture in a patient with poor bone quality. TEA generally yields a lower complication rate, but complications may be more severe than in ORIF.

Figure A is an AP radiograph of a comminuted intraarticular distal humerus fracture.
Figure B is a coronal cut of a CT demonstrating a comminuted intraarticular distal humerus fracture, demonstrating fracture propagation through the medial and lateral columns.

Incorrect Answers
Answer 1: An olecranon osteotomy may be performed if ORIF is the treatment plan, but is not a component of the surgical plan for TEA.
Answer 2: Ulnar nerve dysfunction is a potential complication of both TEA and ORIF.
Answer 3: Motion postoperatively is likely superior with TEA.
Answer 4: There is no clear evidence regarding TEA and immobilization. Certainly, prolonged immobilization has not been shown to improve outcomes following TEA.