Total Elbow Arthroplasty for Distal Humerus Fractures in Japanese Elderly Patients: Clinical Outcomes of 23 Cases with Minimum 2-year Follow-up.

INTRODUCTION

Open reduction and internal fixation (ORIF) with articular reconstruction is the standard treatment for distal humerus fractures; however, ORIF is challenging in elderly patients with severe comminution and poor bone quality. Although favorable outcomes of total elbow arthroplasty (TEA) have been reported for complex distal humerus fractures deemed unsuitable for ORIF, clinical data in Japanese patients remain limited. This study reports the clinical outcomes of TEA in Japanese patients aged 65 years or older when ORIF was deemed unfeasible.

METHODS

We retrospectively reviewed 23 consecutive Japanese patients who underwent primary TEA for complex distal humerus fractures at our institution and had a minimum follow-up of 2 years. The mean age at surgery was 79.3 (standard deviation [SD] 9.0) years (range 65-95 years), and the cohort comprised two men and 21 women. The mean follow-up duration was 40.1 (SD 20.1) months. All procedures were performed via the Campbell approach with ulnar nerve release and anterior transposition. Distal bone fragments were excised, and cemented semiconstrained prostheses were implanted (Coonrad-Morrey: n = 8 [34.8%]; Nexel elbow: n = 15 [65.2%]). Outcome measures included operative time, range of motion (flexion, extension, pronation, and supination), Mayo Elbow Performance Score (MEPS), and postoperative complications.

RESULTS

The mean operative time was 138.9 (SD 19.2) minutes. At final follow-up, the mean range of motion was 125.4° (SD 15.3°) for flexion, -15.3° (SD 16.1°) for extension, 75.9° (SD 4.8°) for pronation, and 74.3° (SD 5.1°) for supination. The mean MEPS was 76.7 (SD 14.4) points. Complications included heterotopic ossification, aseptic loosening of the humeral component, and superficial and deep infections. The overall complication rate was 26.1%, with a reoperation rate of 4.3%.

CONCLUSIONS

TEA demonstrated satisfactory functional outcomes and good range of motion in Japanese elderly patients. Complication rates were within acceptable ranges reported in the literature. TEA may be a viable option for complex distal humerus fractures in the Japanese population.