Total Elbow Replacement for Acute Fractures and Late Complications of Fracture Fixation Around the Elbow- Clinical and Radiographic Outcome at 5-Year Follow-Up

Background: Complex fractures around the elbow, not amenable to reduction and internal fixation, or late complications of the treatment of such fractures (fracture sequela) may necessitate total elbow replacement (TER). We evaluated the clinical and radiographic outcomes of our patients who were treated with TER for these indications.

Methods: Twenty-four patients with a mean age of 64±12 years (range 43-84 years) underwent TER (Discovery Elbow System, Biomet Inc.) for acute complex fractures (16 patients) or fracture sequela (8 patients) and were followed-up for a mean of 68±30 months (range 24-108 months). Outcome measures (preoperative for the fracture sequela group and postoperative for both groups) included the Mayo Elbow Performance Score (MEPS), Subjective Elbow Value (SEV), pain rating (numerical 0-10 scale), elbow flexion and extension (degrees) and elbow radiographs.

Results: Postoperatively, the mean MEPS, SEV, pain rating and elbow flexion-extension arc were 69±21, 59±20, 3.3±2.2 and 91±22 respectively. There were no significant differences between the acute fractures group and the fracture sequela group. However, in the fracture sequela group there was a significant improvement after TER in all clinical scores (MEPS improved from 32±10 to 63±24, SEV improved from 24±7 to 52±21, pain decreased from 6.2±1.3 to 4.0±2.6 and flexion-extension arc increased from 51±28 to 89±29; p<0.05). Complications occurred in 5/24 patients (21%) and included aseptic component loosening in 2 patients (1 ulnar and 1 humeral), periprosthetic ulnar fracture in 1 patient, deep infection in 1 patient and radio-ulnar synostosis in 1 patient.

Conclusion: TER yielded fair results in our patients at 5.5-year follow-up. However, when performed for late complications of complex elbow fractures TER provided significant clinical improvement and pain relief. The relatively high rate of complications remains a concern when considering the risk versus benefit of operating on these challenging cases.