Total Elbow Arthroplasty in the Setting of an Olecranon Fracture

Abstract

Total elbow arthroplasty (TEA) has gained popularity over the last decade due to the growing elderly population requiting definitive treatment for rheumatologic disease or traumatic conditions of the elbow. Several methods exist to address triceps muscle and tendon insertion, including triceps fascial tongue exposure, reflecting the triceps medially or laterally, and even conducting an olecranon osteotomy. In the setting of a distal humerus fracture, there has been concern regarding using an osteotomy with regard to the fixation of the ulnar component and osteotomy healing. The senior author, in particular, has avoided using this approach, despite its superior visualization of complex articular fractures, for these reasons. We present a surgical technique that can lead to a successful TEA and olecranon union in the setting of a comminuted distal humerus fracture combined with a displaced olecranon fracture. In this technique, the olecranon fragment was used to achieve superior surgical exposure for our TEA technique and allowed us to achieve good postoperative outcome. This has led us to be more willing to use an olecranon osteotomy for distal humeral fracture visualization in cases where a TEA may be needed.