This is a retrospective study done on 26 patients with a diagnosis of rheumatoid arthritis, who sustained fractures of the distal humerus. In 6 of 26 patients, there was an associated fracture of the olecranon. All patients underwent Souter total elbow arthroplasty (unconstrained) with an associated osteosynthesis of the supracondylar portion of the fracture in 20 patients and of the olecranon fracture in 6 patients. Fixation included cerclage wires, K-wires, and PDS sutures as well as miniature plates. The goal of the study was to document union of these fragments as well as the mid-term results. The findings demonstrated that 20 of the 32 fractures united and 12 of them had not united. Three of the patients had radiographic evidence of loosening, two of the patients had avulsion rupture of the triceps tendon, and there was one late infection. Thus, there was a complication in 6 of 26 cases (a 23% complication rate) at a mean of 2.6 years.
The significance of this study is that distal humerus fractures in a rheumatoid patient with extension into the supracondylar region is not a contraindication to total elbow arthroplasty, although a high complication rate is expected. It appears from the results of this study that approximately 62% of fractures will unite. If there is not significant underlying joint arthrosis and the fracture is amenable to internal fixation, this remains the treatment of choice in younger individuals with rheumatoid arthritis. The most significant weakness in this study is that the time interval between fracture and arthroplasty was variable, between 0-48 months, indicating that some of these fractures were treated in a delayed fashion. This was not taken into account in the interpretation of the results.