Prosthetic replacement of elbow for intercondylar fractures (recent or ununited) of humerus in the elderly

Forty-one patients with an intercondylar fracture of the humerus (21 recent and 20 ununited) were treated by total elbow arthroplasty using Baksi's recent version of the sloppy hinge from January 2003 to April 2009. Twelve were AO classification type C2 and nine were type C3 recent closed fractures of seven days' mean duration according to Muller classification. Patient's mean age was 64 years. There were 20 nonunions (nine untreated nonunions of a mean of 11 months duration and 11 following failed internal fixation of a mean of 14 months duration); mean patient age was 58 years. The follow up period was 12-88 (mean 55.5) months. Mean arc of postoperative elbow flexion was 25-130A degrees obtained in 39 (95.1%) patients. Mean arc of 65A degrees pronation and 60A degrees supination was obtained in 33(80.5%) patients. According to the Mayo elbow performance score, in the fresh-fracture group, excellent results were seen in 19 (90.5%), good in one (4.8%), and failure in one (4.8%), whereas in the nonunion group, excellent results were obtained in 17 (85%), good in two (10%), and failure in one (5%). Failure in the two patients was due to deep infection requiring prosthesis removal. Other complications were transient ulnar neurapraxia in three, disassembly of the prosthesis in one, patchy heterotopic ossification in two and localised radiolucency around the flanges of the humeral stem in one.