Treatment of distal humeral fractures in elderly patients: Where are we in 2020? A review article

Distal humeral fractures are increasing in the elderly population and pose a difficult clinical problem as orthopaedic surgeons attempt to maximize return of function and avoid complications. Many treatments have been suggested for distal humeral fractures in the elderly, with operative intervention becoming a mainstay of treatment for active patients. Open reduction internal fixation (ORIF) and total elbow arthroplasty (TEA) have been utilized with both success and complications. The available literature appears to be equivocal on the ideal treatment of geriatric distal humeral fractures, with well-done TEA and ORIF demonstrating similar outcomes. Failed fixation of geriatric distal humeral fractures can be reliably converted to TEA without worsened outcomes but requires a second surgery. TEA demonstrates equivalent outcomes, but with activity limitations for the lifespan of the patient that may inhibit the use of walking aids. There also may be decreased hardware survivorship when TEA is employed for acute fracture. Surgeons and patients must weigh the risks and benefits of treatment with TEA associated with functional restrictions and possible decreased hardware survivorship. TEA does not have the reliable fallback option, but ORIF requiring a second surgery can be converted to TEA.