The role of total elbow arthroplasty as a primary treatment for distal humeral fractures

Fractures of the distal humerus are rare and account for only a small proportion of fractures in adult patients. Due to demographic changes surgeons will be faced with an increasing number of complex multifragment fractures with diminished bone quality in geriatric patients. As conservative treatment frequently leads to limited and painful elbow function, open reduction and stable internal fixation with early range of motion exercises are considered the gold standard. However, in combination of comminution and an osteoporotic bone stock, complication rates remain considerably high and stable fixation might be impossible. In these patients primary total elbow arthroplasty has become increasingly popular in recent years. Since Cobb and Morrey published their landmark paper on the use of total elbow arthroplasty for distal humeral fractures it has become accepted that this technique is a valuable treatment option. Detailed knowledge and understanding of the technical aspects of total elbow arthroplasty are the key factors for a successful procedure and patient satisfaction. This articles highlights the history of total elbow arthroplasty for trauma fractures, provides detailed information on the correct indications, the operative procedure, results and complications.