[Articular Fractures in the Elderly: to Fix or to Replace? - Distal Humerus]

Distal humeral fractures in adults are rare. They are routinely treated by open reduction and internal fixation in an attempt to retain a painless, stable and functional joint. However, even with advances in plate technology, the results of fixation still depend on screw purchase and bone quality. Even if functional results appear to be favourable, complication rates remain quite high. This is particularly true in elderly patients, in whom multifragmentary intraarticular fractures are mostly associated with diminished bone quality. Recent results support the use of primary total elbow arthroplasty in patients with highly comminuted distal humeral fractures. This applies particularly to the elderly with low physical demands, or patients with marked joint destruction from significant preexisting inflammatory joint disease. Although short term results seem to be promising, the intermediate and long term data are still inadequate. There is indeed evidence for a dramatic increase in complications and revision rates over time. Lifelong weight restriction is a major drawback in total elbow arthroplasty. It is unclear whether the primary treatment of distal humeral fractures in the elderly should be open reduction and internal fixation or total elbow arthroplasty. The operation should be selected for the individual patient on the basis of the surgeon's experience and judgment as well possible contraindications. The surgeon should discuss the question openly with the patient.