This multicenter RCT randomized 42 patients over 65 with OTA type 13C distal humeral fractures to ORIF or primary semiconstrained total elbow arthroplasty. It is the first prospective randomized trial to compare these two approaches in elderly patients, providing Level I evidence where only retrospective series had existed.
For every elderly patient with a comminuted OTA type 13C distal humeral fracture, the operative plan should include TEA as a primary option — not just a backup.
The 25% intraoperative conversion rate is reproducible across multiple studies and represents a biologically distinct subset of fractures that cannot be stabilized. Booking these cases without TEA implants available is a setup for a bad outcome.
When you see a DASH score that has 'caught up' in an elderly ORIF patient at 1-2 years, do not interpret this as equivalence. The MEPS remains significantly worse, and the authors' data suggest these patients are adapting to limitation rather than recovering from it.
The 2-year follow-up is a real constraint: TEA longevity data at 7-10 years (85-90% survival in low-demand elderly women) support this approach for the typical patient, but younger or higher-demand patients warrant caution given the irreversibility of condylar resection.
This multicenter RCT randomized 42 patients over 65 with OTA type 13C distal humeral fractures to ORIF or primary semiconstrained total elbow arthroplasty. It is the first prospective randomized trial to compare these two approaches in elderly patients, providing Level I evidence where only retrospective series had existed.
For every elderly patient with a comminuted OTA type 13C distal humeral fracture, the operative plan should include TEA as a primary option — not just a backup.
The 25% intraoperative conversion rate is reproducible across multiple studies and represents a biologically distinct subset of fractures that cannot be stabilized. Booking these cases without TEA implants available is a setup for a bad outcome.
When you see a DASH score that has 'caught up' in an elderly ORIF patient at 1-2 years, do not interpret this as equivalence. The MEPS remains significantly worse, and the authors' data suggest these patients are adapting to limitation rather than recovering from it.
The 2-year follow-up is a real constraint: TEA longevity data at 7-10 years (85-90% survival in low-demand elderly women) support this approach for the typical patient, but younger or higher-demand patients warrant caution given the irreversibility of condylar resection.