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

Background: Geriatric distal humerus fractures are difficult to manage. Open reduction and internal fixation remain the standard, but total elbow arthroplasty (TEA) appears to be a viable alternative. This study evaluated the long-term outcome after primary TEA in comparison to secondary TEA. Methods: In this retrospective cohort study with prospective follow-up (FU), patients undergoing TEA after complex distal humerus fractures were analyzed as either primary TEA (index treatment; n = 21) or secondary TEA (salvage procedure after failed fracture treatment; n = 13). Data extracted from the medical records and the final clinical FU included demographics, fracture type, Mayo Elbow Performance Score, Disabilities of the Arm, Shoulder and Hand, patient satisfaction, range of motion (flexion-extension and pronation-supination), normalized handgrip strength, Janda muscle strength grades (flexion, extension, pronation, supination), complications, and revisions. Results: From 2003 to 2012, 57 TEAs were performed; 34 patients with semiconstrained prosthesis models met the study criteria and were available for analysis (21 primary, 13 secondary; 7 men, 27 women). The remaining 23 cases were excluded because of non-post-traumatic indications, prosthesis types outside the inclusion criteria, or unavailable analyzable FU of at least 5 years. Mean FU was 8 years (range, 5-13). Mean age at surgery was 62 ± 15 years (23-85), with no difference between primary and secondary TEA ( Conclusion: In this Level III retrospective cohort comparison, primary TEA was associated with better mid- to long-term functional scores and patient satisfaction than secondary TEA. However, several clinically relevant numerical differences, including range of motion, complication rate, and revision rate, did not reach statistical significance and should be interpreted cautiously in light of the limited sample size, retrospective design, and potential selection bias. Prospective multicenter studies and registry data are needed to refine indications and long-term expectations.