Total elbow arthroplasty for distal humeral fractures in the elderly population: good functional outcomes and a high implant survival rate can be expected after surgery

Introduction Distal humeral fractures in elderly patients are difficult to treat due to poor bone quality and high complication rates. Total elbow arthroplasty (TEA) is an alternative for non-reconstructable fractures. This study aimed to evaluate long-term outcomes and implant survival of elderly subjects treated with linked TEA for acute distal humeral fractures. Methods A retrospective study was conducted on data from patients who underwent TEA between January 2017 and December 2024 with fractures unsuitable for open reduction and internal fixation (ORIF). Clinical (range of motion, visual analogue scale, Mayo Elbow Performance Score, the Quick Disabilities of the Arm, Shoulder, and Hand score, and the American Shoulder and Elbow Surgeons score) and radiographic outcomes, complications, and implant survival were analysed. Results Thirty-seven patients (mean age 80.4 ± 5.1 years) were followed for a mean of 107 ± 54 months. TEA permitted achievement of a good ROM (flexion 130 ± 8.16°; extension 19.8 ± 11.4°), and functional outcomes (VAS 3.3 ± 1.3, MEPS 83.5 ± 7.3, DASH 54 ± 4.4, ASES 78 ± 12.9) at the final follow-up. Revision rate was 11%, and 5-year implant survival was 94.2%. Comorbidities did not significantly influence clinical outcomes. Conclusion TEA provides reliable long-term function and pain relief with acceptable complication rates in elderly patients with complex distal humeral fractures, supporting its use as a primary treatment in selected cases.