The number of fractures of the distal humerus in older adults is rising due to an ageing population and an increasing incidence of fragility fractures. The management is based on the patient's preference, the pattern of the fracture, the quality of the bone and soft-tissue, the patient's comorbidities and potential for rehabilitation, as well as balancing the risk of complications such as infection, nonunion, instability, or loosening. Nonoperative treatment remains appropriate for a few low-demand or medically unfit patients. Open reduction and internal fixation (ORIF) or arthroplasty, either hemiarthroplasty (HA) of the elbow or total elbow arthroplasty (TEA), provide good outcomes when appropriately selected. An increase in the use of arthroplasty for trauma is shown in registry data, although the indications and survival remain controversial with few robust comparative and long-term data. Similar short- to mid-term functional outcomes between ORIF and TEA have been reported in recent comparative studies, with a trend towards an increased reoperation rate after ORIF, but the evidence is derived largely from small retrospective observational studies. HA of the elbow may be a viable alternative for active older patients, particularly when stable fixation is not achievable, although instability and conversion to TEA may be required. The aim of this review was to synthesize the current evidence dealing with the indications, techniques, and outcomes for nonoperative management, ORIF and arthroplasty in older patients with a distal humeral fracture.

Distal humerus nonunion in adults: Management strategies and contemporary outcomes.

Elbow hemiarthroplasty is not the "half" of elbow arthroplasty.

Survival and Recurrence of Infection After Revision of Infected Total Elbow Arthroplasty: A French Multicenter Study (2013-2023) of 137 infected Total Elbow Arthroplasties.

How Does a Prior Olecranon Osteotomy Impact the Outcome of Subsequent Total Elbow Arthroplasty?

Morrey Award 2025: Cell Count and Differential of Aspirated Fluid in the Diagnosis of Periprosthetic Joint Infection of Total Elbow Arthroplasty.

Total elbow arthroplasty (TEA) has become a well-established surgical option for advanced elbow disorders. The Nexel prosthesis (Zimmer Biomet, Warsaw, IN, USA) has been associated with mechanical complications and implant instability in previous international reports. However, no clinical outcomes have been published for Japanese patients. This study aims to evaluate the short- to mid-term clinical outcomes of the Nexel TEA in a Japanese cohort. We retrospectively reviewed 31 elbows in 30 patients (6 men, 24 women; mean age 73.0 years) treated with the Nexel prosthesis between 2015 and 2023, with a minimum follow-up of 24 months (mean 47.4 months). Primary diagnoses included rheumatoid arthritis (n = 9), fracture (n = 19), and osteoarthritis (n = 3) with some overlap. Clinical outcomes were assessed using the Mayo Elbow Performance Score, range of motion, and complication incidence. The mean post-operative Mayo Elbow Performance Score was 79.3 points, reflecting generally favorable outcomes. Mean range of motion values were flexion 125.9°, extension -16.9°, pronation 76.5°, and supination 71.7°. Complications comprised aseptic loosening in 2 elbows, a periprosthetic olecranon fracture in 1, transient radial nerve palsy in 1, superficial infection in 3, and heterotopic ossification in 1. Most complications were managed successfully either conservatively or with minor revision. Despite prior concerns regarding early mechanical failure of the Nexel prosthesis, the present series demonstrates stable and satisfactory short- to mid-term outcomes in a Japanese patient population characterized by a high incidence of fracture indications and predominantly elderly, low-demand patients. These results may reflect careful surgical technique (including routine olecranon tip osteotomy to avert anterior flange impingement) and strict post-operative load-restriction protocols. Ongoing long-term follow-up and multicenter Japanese studies are required to confirm implant durability.

BackgroundElbow arthrodesis (EA) is a rare salvage procedure for non-reconstructible elbow conditions and failed total elbow arthroplasty (TEA).Materials and methodsWe retrospectively analyzed 20 adults treated with EA between 2010 and 2024, comparing contact arthrodesis (n = 12) with distance/defect arthrodesis after induced membrane technique (IMT) reconstruction (n = 8). Indications were infection in nine patients, trauma in three patients, osteoarthritis in three patients, non-union in three patients, and inflammatory arthritis in two patients. Outcomes included grip strength, wrist range of motion (ROM), patient-reported outcome measures (PROMS) Oxford Elbow Score (OES), Mayo Elbow Performance Score (MEPS), abbreviated Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Single Assessment Numeric Evaluation (SANE), complications, and return to work.ResultsPrimary radiographic fusion was observed in 18 of 20 patients; two patients required revision surgery for nonunion, here secondary fusion was achieved with distance arthrodesis. The mean fixation angle was 102 ± 11°. At a mean follow-up of 4 ± 4 years, no statistically significant differences in PROMS or objective measures were detected between contact and distance arthrodesis. Relative grip strength on the operated side was 0.74 of the contralateral side, and wrist ROM was reduced. In dominant-hand injuries, fixation angle correlated with relative wrist radial-ulnar deviation ROM (r = 0.668, p = 0.009). Peri-implant fractures of the proximal ulna occurred in seven patients and intraoperative bleeding in four. Among patients of working age, 12 of 15 returned to work.ConclusionsNo statistically significant differences in clinical outcomes were detected between defect/distance and contact arthrodesis; however, equivalence cannot be concluded from this underpowered exploratory cohort. Elbow arthrodesis remains a salvage procedure with substantial complication risk. Individualized fusion angle selection, local bone stock, infection status, and patient-specific occupational demands should be considered carefully during preoperative counseling and surgical planning.Level of evidenceLevel III, retrospective comparative cohort study.

Preoperative Proton Pump Inhibitor Use and Risk of Adverse Outcomes After Total Elbow Arthroplasty: A Propensity-Matched Analysis.

Distal humerus fractures are rare but technically challenging. Intra-articular patterns may predispose patients to post-traumatic osteoarthritis, potentially requiring total elbow arthroplasty (TEA). This study compared TEA incidence after intra- versus extra-articular distal humerus fracture fixation across age groups. The TriNetX database (2006-2026) was queried for patients undergoing open reduction and internal fixation (ORIF) of distal humerus fractures. Patients were stratified into younger (10-40 years) and older (>50 years) cohorts and classified as extra-articular (current procedural terminology (CPT) 24545) or intra-articular (CPT 24546, 24586, 24579). Cohorts were 1:1 propensity-matched for demographics and comorbidities. Younger patients were analyzed as a combined cohort. Kaplan-Meier analysis estimated TEA incidence at 1, 3, 5, and 10 years. In the older cohort (2181 patients/group; mean age ∼70 years), intra-articular fractures demonstrated significantly higher TEA conversion at 1 year (3.9% vs. 1.6%), 3 years (4.3% vs. 2.1%), 5 years (4.3% vs. 2.1%), and 10 years (4.4% vs. 2.2%) (all ps < 0.05; odds ratio: 2.02-2.46). Kaplan-Meier analysis confirmed lower TEA-free survival in intra-articular patients (p < 0.001). TEA conversion remained rare in younger patients (1.04% at 10 years). TEA conversion after distal humerus ORIF is uncommon overall but varies by age and fracture pattern, supporting individualized counseling. Level III, Prognostic.

Efficacy and safety of elective primary total elbow arthroplasty in the last 25 years: a systematic review.

Primary vs. revision total elbow arthroplasty: an updated analysis of short-term complications and associated factors

Revisions for periprosthetic joint infection following total elbow arthroplasty (TEA) can be performed using one- or two-stage protocols. Evidence remains inconclusive regarding which approach results in lower reinfection rates. This study aimed to compare reinfection outcomes. Secondary outcomes were planned but not analysed due to limited data. PubMed, MEDLINE, Embase, and the Cochrane Library were searched for studies reporting reinfection following one- or two-stage TEA revision. Two reviewers independently extracted data, with discrepancies resolved by a third reviewer. Pooled reinfection rates were calculated using random effects models. Four studies (16 patients) reported one-stage revision, with a pooled reinfection rate of 18.8% (95% CI: 3.75-57.7%) and no heterogeneity (I2 = 0%). Fifteen studies (235 patients) reported two-stage revision, with a pooled reinfection rate of 22.0% (95% CI: 13.0-34.3%) and low heterogeneity (I2 = 10%). Sensitivity analysis excluding one outlier increased the rate to 24.3% (95% CI: 14.7-37.4%). Evidence comparing one- and two-stage revision for infected TEA is limited. Pooled reinfection rates were numerically similar, but data are insufficient to determine comparative effectiveness. Prospective studies are required.

Total Elbow Arthroplasty Complication, Reoperation, and Revision Rates: A Comparison Between Arthroplasty for Arthritis Versus Fracture.

With equal numbers of adults with unreconstructable distal humerus fractures undergoing total elbow arthroplasty (TEA) and distal humerus hemiarthroplasty (DHH) a randomized trial is needed to compare the interventions. Patients have identified pain as the key outcome. There are no data on pain outcomes using a validated pain instrument to plan a trial. This study aims to use expert elicitation to produce probability distributions for the Patient Rated Elbow Evaluation (PREE) pain score at 12 months in adults undergoing TEA or DHH for trauma. Using the Sheffield Expert Elicitation Framework seven experts were recruited and provided with a summary of current knowledge on pain outcomes from a systematic review. They were asked to consider their median of the PREE pain score at 12 months after a TEA for acute trauma, their difference in the median PREE pain scores between TEA and DHH, and their standard deviation (SD) of the PREE pain score after TEA and DHH. The rational independent observer concept was used to achieve consensus. The elicited median value for the PREE pain at 12 months after TEA for acute trauma was 13.6/50 (interquartile range 10.6 to 16.8). The estimated median of the difference in PREE pain scores was 3.4 (interquartile range -0.3 to 7.1). The elicited standard distribution of PREE pain scores was 9 (SD 2.2), and after DHH was 12 (SD 3.0). Probability distributions for pain outcomes measured using the PREE pain subscale following DHH and TEA for acute trauma in adults generated by expert elicitation indicate an expectation of small differences between interventions. A noninferiority randomized trial using the PREE pain subscale as the primary outcome at 12 months could be conducted to explore whether the possible advantages of DHH, such as lower cost and reduced adverse events, are supported.

The primary aim of this study is to evaluate differences in inpatient charges between primary (pTEA) and revision (rTEA) total elbow arthroplasty among Medicare and Medicaid patients. Our secondary aim is to assess whether these charges vary across hospitals with differing total elbow arthroplasty (TEA) procedural volumes. We hypothesize that rTEA would be more expensive than pTEA and that charges would be higher for low-volume hospitals. The Statewide Planning and Research Cooperative System database was queried for all Medicare and Medicaid Services patients who underwent a pTEA or rTEA in New York State from 2010 to 2020. Hospitals were classified as high-volume (≥3 surgeries/year), medium-volume (between 2-3 surgeries/year), or low-volume (less than 2 surgeries/year). Facilities performing fewer than 1 surgery per year or with fewer than 4 years of TEA data were excluded. Total inpatient charges were collected and subsequently subdivided into ancillary and accommodation charges. Inpatient charges and readmission data were compared across the 2 procedures and volume groups. During the study period, 1,303 patients underwent pTEA and 273 underwent rTEA. After adjusting for patient age, sex, race, and hospital volume, rTEA was independently associated with significantly higher accommodation, ancillary, and total inpatient charges (P < .001 for all). Additionally, rTEA patients had a higher likelihood of 90-day readmission (P = .005) and longer inpatient stays (P < .001) compared to pTEA patients. There were observable differences in total, accommodation, and ancillary charges across hospital volume groups for both pTEA and rTEA. Low-volume hospitals demonstrated the highest total charges for pTEA during the study period vs. high- and medium- volume hospitals (P < .001 for pTEA, P > .05 for rTEA). rTEA is associated with longer inpatient stay, higher inpatient charges, and greater readmission rates compared to pTEA. Primary TEA in low-volume hospitals is associated with higher total charges compared to medium and high-volume hospitals. These findings provide valuable insights for hospital administrators and public health officials aiming to create effective strategies to manage costs and combat the growing burden of healthcare expenses in the United States.

Coronal shear fractures of the distal humerus are rare but severe injuries. Reconstruction is often challenging, especially in comminuted cases, which is why many surgeons opt for an elbow arthroplasty in those cases. However, total elbow arthroplasty is associated with a variety of potential problems itself. Therefore, the aim of this study was to present the functional and clinical outcome of coronal shear fractures treated by osteosynthetic reconstruction in a short- to mid-term follow-up, and to identify possible risk factors for an inferior outcome. We performed a retrospective follow-up assessment of 51 consecutive patients (30 women; median age 56 years, (IQR 39-62)) who underwent osteosynthetic reconstruction for coronal shear fractures between 2012 and 2022 after a minimum follow-up period of two years. The Mayo Elbow Performance Score, Oxford Elbow Score, and Disabilities of the Arm, Shoulder and Hand score were evaluated, and all available radiographs were analyzed. All complications and revision procedures were assessed. Univariable and multivariate regression analyses were performed to identify potential risk factors for a poor outcome following osteosynthetic reconstruction. After a median follow-up period of 43 (IQR 28-78) months, the median Mayo Elbow Performance Score was 100 (IQR 85-100), the median Oxford Elbow Score was 42 (IQR 34-46), and median Disabilities of the Arm, Shoulder and Hand score was 6 (IQR 2-28). The median ROM was 148° (IQR 126-155) for flexion, 0° (IQR 0-0) for extension, 90° (IQR 85-90) for pronation, and 90° (IQR 85-90) for supination. There was no extension deficit on the injured site. The overall complication and reoperation rates were 35.3% and 27.4%, respectively, with severe elbow stiffness being the most common reason for revision. Increasing Dubberley classification and posterior comminution were significantly associated with a poor outcome and higher rates of complications and revision. This short- to mid-term follow-up shows good functional results after osteosynthetic reconstruction in coronal shear fractures despite high complication and revision rates. However, increasing Dubberley classification, posterior comminution and the presence of complications show inferior outcome scores. This study shows that osteosynthetic reconstruction can be an option even in comminuted coronal shear fractures. Nevertheless, patient factors need to be considered and an individual decision concerning the surgical treatment is necessary. Patients should be counseled about the high complication rates and inferior outcome with increasing Dubberley classification. Level III.

Nerve injury in revision total elbow arthroplasty: a systematic review and meta-analysis.

Mid- and long-term results of primary vs. secondary total elbow arthroplasty after index intra-articular fracture of the distal humerus in the elderly

Total elbow arthroplasty for unreconstructible distal humerus fracture sequelae in patients less than 40 year old. Long-term outcomes