Indications

• Unreconstructable comminuted distal humerus fracture.

• Elderly, low-demand patient (>70 years).

• Osteoporosis.

Note

• Lack of expertise in fixation of these fractures does not equate to the fracture being unreconstructable. Refer to a more experienced surgeon for fixation if necessary. The results of TEA are better than ORIF in the elderly. The results of revision of a failed fixation to a TEA are inferior to a primary TEA.

Contraindications

• Infection.

• Lack of soft tissue coverage.

• Age under 70 years.

• Non-compliant patient.

• Neurological injury afecting the elbow lexors.

Preoperative planning

Clinical assessment

• Full history and examination. Document status of radial, ulnar, median and posterior interosseous nerves individually.

• Exclude associated injuries.

Radiological assessment

• Plain radiographs of the elbow: anteroposterior and lateral views (Fig. 4.1.1).

• A CT scan is oten very helpful to deine the pattern of fracture and the extent of intra-articular comminution.

• Up to 2 cm of humeral shat bone loss can be addressed using standard implants. Greater than 2 cm of bone loss requires the use of implants with extra-long anterior flanges.

• Determine the humeral and ulnar canal diameters to conirm that they can accommodate the implants.

Preoperative consent

• Obtain informed consent from the patient, including but not limited to risks, beneits, alternatives, complications and potential outcome.