Arthroplasty

There are two options for arthroplasty when treating a distal humeral fracture:

• Total elbow arthroplasty
• Hemiarthroplasty of the distal humerus

Elbow arthroplasty is a challenging decision-making process and procedure which requires experience in arthroplasty and managing related complications.

A total elbow arthroplasty performed for fractures is an inherently stable construct as the humeral and ulnar components are linked.

A potential disadvantage of this technique is the risk of stem loosening because of load transfer to the stem-cement-bone interface and polyethylene wear at the implant linkage.

In case of preexisting elbow arthritis or in a patient with associated unreconstructable osseous or ligamentous instability lesions, a total elbow arthroplasty should be considered.

• Total elbow arthroplasty

Specific indications

• Fractures in patients with symptomatic preexisting elbow arthritis
• Unreconstructable osseous or ligamentous instability lesions (radial head and coronoid fractures)

Relative contraindications

• Patients with associated olecranon fracture
• Younger active patients

Advantages

• Established technique

Disadvantages

• Potential activity restrictions
• More complex revision procedures

Hemiarthroplasty is an unlinked articulation.

Joint stability in this technique is reliant on anatomical repair of the native collateral ligaments around the implant.

Potential disadvantages of this technique are joint instability and wear of the native olecranon and radial head.

• Hemiarthroplasty

The general indications for hemiarthroplasty are the same as for total elbow arthroplasty.

Specific indications for hemiarthroplasty

• Unreconstructable intraarticular fractures in younger patients (anatomical reconstruction is the preferred option for in this patient group)

Relative contraindications

• Fractures in patients with symptomatic preexisting elbow arthritis
• Unreconstructable osseous or ligamentous instability lesions (radial head and coronoid fractures)

Advantages

• No polyethylene or bearing related complications
• Less rigid activity restrictions

Disadvantages

• Ulnar trochlea cartilage erosion
• Implant not universally available