The best surgical treatment for a patient with rheumatoid arthritis
and an acute distal humeral fracture is not well established.
Because of the distorted anatomy of the arthritic elbow joint and
the adjacent osteoporotic bone, total elbow arthroplasty may be
favored over open reduction and internal fixation in these patients.
We retrospectively analyzed a series of patients with rheumatoid
arthritis in whom an acute distal humeral fracture had been treated
with either open reduction and internal fixation or total elbow
arthroplasty; our purpose was to evaluate their outcomes and to
identify any influence of age, fracture type, or the extent of the
rheumatoid involvement of the elbow joint on the choice of
Between 1982 and 2002, an acute distal humeral fracture was treated
surgically in sixteen elbows in fourteen patients with rheumatoid
arthritis, and the results were retrospectively reviewed at a
minimum of twenty-four months postoperatively. Six elbows were
treated with open reduction and internal fixation (Group 1) and ten
elbows, with primary total elbow arthroplasty (Group 2).
Postoperatively, the elbows were examined with standard radiographs,
and the clinical outcome was assessed with the Mayo Elbow
Performance Score (MEPS).
Six patients (six elbows) died before the time of the study, but
they had been followed for more than twenty-four months and
therefore were included in the series. The eight patients (ten
elbows) who were still alive were examined. The mean duration of
follow-up was forty-nine months in Group 1 and sixty-six months in
Group 2. The MEPS averaged 93 points in Group 1 and 96 points in
Group 2. Radiographically, all fractures had healed uneventfully in
Group 1 and no prosthesis was loose in Group 2. We could not
identify any difference between Groups 1 and 2 with respect to
patient age, fracture type, or extent of the rheumatoid
LEVEL OF EVIDENCE
Distal humeral fractures in patients with rheumatoid arthritis can
be treated successfully with immediate open reduction and internal
fixation or with total elbow arthroplasty. Our data suggest that
open reduction and internal fixation can be successful when there is
mild arthritic involvement. We favor total elbow arthroplasty for
patients with severe articular involvement.
Therapeutic Level IV. See Instructions to Authors for a complete
description of levels of evidence.