CURRENT CONCEPTS IN ADULTS UPPER EXTREMITY FRACTURES

21452Ugur_TiftikciCurrent_Consept_in_adults.kapak

ARTHROPLASTY IN THE TREATMENT OF DISTAL HUMERAL FRACTURES

Mert Erdem Yeşilli

Ankara Training and Research Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye

Yeşilli ME. Arthroplasty in The Treatment of Distal Humeral Fractures. In: Tiftikçi U, Erdoğan E, Ergün C, Güneş Z, editors. Current Concepts in Adults Upper Extremity Fractures. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.137-142.

ABSTRACT

The management of distal humerus fractures is highly challenging, and the outcomes remain controversial in terms of the techniques employed. The choice of treatment must always consider the patient’s expectations, physiological condition, bone quality, and the type and classification of the fracture fragmentation. Some authors argue that, regardless of the chosen treatment, the outcome should aim to achieve at least 100-120 degrees of elbow joint range of motion. Elbow arthroplasty is a viable option for managing complex intra-articular distal humerus fractures where open reduction and internal fixation (ORIF) is either not feasible or particularly challenging (e.g., in elderly patients, those with rheumatoid sequelae, or highly comminuted fractures). It is also indicated in cases where the patient had pre-existing arthritic conditions in the elbow joint prior to the trauma, or in cases of nonunion of comminuted intra-articular distal humerus fractures, either as a primary intervention or as a secondary option following failed fixation surgeries. Types of elbow arthroplasty include total elbow arthroplasty, hemiarthroplasty, resection arthroplasty, and interposition arthroplasty.

Total Elbow Arthroplasty (TEA) is indicated in non-active and non-young populations with osteoporotic fractures, irreconstructible or unfixable comminuted intra-articular distal humerus fractures, and in patients who have previously undergone ORIF procedures but have developed post-traumatic arthritis. In contrast, in active and younger populations, TEA is indicated in cases of loss of reduction, nonunion, or avascular necrosis following ORIF procedures for intra-articular distal humerus fractures.

Elbow Hemiarthroplasty is indicated in younger and more active patient populations with isolated and irreconstructible comminuted fractures of the intercondylar region, capitellum, or trochlea, or in cases of nonunion of these fractures. Recently, hemiarthroplasty has gained attention due to its lower dissection requirements and reduced complication rates compared to TEA. Hemiarthroplasty can be considered a form of surface replacement surgery.

Interposition Arthroplasty and Resection Arthroplasty, unlike prosthetic elbow arthroplasty, are options primarily considered for younger, active, and labor-intensive populations who develop post-traumatic arthritis in the chronic phase and are not suitable candidates for total elbow arthroplasty.

Keywords: Arthroplasty; Replacement; Elbow; Humeral fractures; Distal; Fractures; Comminuted; Osteoporotic fractures; Aged; Hemiarthroplasty

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