Treating
intra-articular fractures about the osteoporotic distal humerus poses a significant challenge. The purpose of this retrospective study was to evaluate functional outcomes for
distal humeral fractures treated with total elbow
arthroplasty (
TEA) or open reduction and internal fixation (ORIF) in a nonarthritic elderly population with
osteoporosis. We reviewed the records of all women older than age 60 who had undergone surgical treatment for intraarticular
distal humerus fractures (Orthopaedic
Trauma Association types 13B and 13C) by 1 of 2 surgeons. Demographic and operative data were obtained, charts were reviewed, and patients were asked to have their outcomes evaluated with the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and the Mayo Elbow Performance Index (MEPI). Twenty-two patients (23 elbows) were identified, and 2 of these (3 elbows) were excluded. Of the remaining 20 patients, 9 had undergone cemented, semiconstrained
TEA as initial treatment, and 11 had undergone ORIF. These 2 groups were compared. Mean follow-up was 14.8 months (range, 6-38 months). There were no significant differences between the
TEA and ORIF groups with respect to demographic factors. Final elbow range of motion was 92° flexion-extension
arc (
arthroplasty group) and 98° (fixation group). Two patients in the
arthroplasty group and 2 in the fixation group died. For the remaining patients, mean DASH scores were 30.2 (
arthroplasty) and 32.1 (fixation), and mean MEPI scores were 79 (
arthroplasty) and 85 (fixation). These differences were not statistically significant. Four TEAs developed radiographic loosening by a mean of 15 months, and 1 of these underwent revision with good outcome. Ten of the 11 fractures in the fixation group healed radiographically; the 1 nonunion with collapse continued to be asymptomatic. Two patients in the fixation group underwent
contracture release after union for limited elbow range of motion. Many factors come into play in the treatment of intra-articular
distal humerus fractures in patients with
osteoporosis. Implant selection must be based on bone quality, expected outcome, and surgeon experience. For these
injuries, good outcomes may be obtained with either
TEA or ORIF.