Elbow Arthroplasty for Distal Humeral Fractures—Technique, Pearls, and Pitfalls

Treatment of distal humeral fractures remains a challenging problem. Recent advances in plating techniques have improved our ability to treat most fractures with open reduction and internal fixation. Although open reduction and internal fixation has become the gold standard, successful treatment requires adherence to the tenets of anatomic reconstruction and stable fixation. In some cases,—particularly in elderly patients with poor bone quality and comminuted, intra-articular fractures—stable, anatomic reconstruction cannot be reliably achieved. Situations in which stable reconstruction is capricious, elbow arthroplasty has emerged as a viable alternative. Total elbow arthroplasty is the procedure of choice for elderly patients, preexisting arthropathy, low functional demand, and when the medial or lateral condyles cannot be reconstructed. Distal humeral replacement (hemiarthroplasty) with an anatomic implant is an option for younger, active patients; however, this requires intact or reconstructible condyles and soft tissue constraints. We present our technique of elbow arthroplasty for unreconstructible distal humeral fractures.