This is a retrospective review of 19 modified Coonrad-Morrey semiconstrained total elbow arthroplasties done specifically for flail or grossly unstable elbows. Most cases followed distal humeral nonunion or trauma, with a few rheumatoid patients. It asks whether a linked implant can restore a stable, functional elbow when instability, not pain, is the primary problem.
When you see a flail or grossly unstable elbow from distal humeral nonunion, trauma, or rheumatoid destruction, the decision rule hinges on age and bone stock. Patients over 60, or younger patients with exhausted bone stock, multiple failed operations, or rheumatoid disease, are candidates for a linked semiconstrained total elbow arthroplasty rather than repeat ORIF, arthrodesis, or allograft.
The key mechanical concept: the Coonrad-Morrey anterior flange reestablishes the axis of rotation relative to the olecranon fossa and provides rotational stability, so missing epicondyles do not preclude a stable reconstruction. This is why custom implants and epicondylar reconstruction were unnecessary.
The tradeoff is a low-demand implant. Two ulnar components fractured during heavy activity, which is why these patients must be counseled to avoid high loads. Under 60 with adequate bone stock, still favor ORIF with autogenous grafting to preserve native joint.
This is a retrospective review of 19 modified Coonrad-Morrey semiconstrained total elbow arthroplasties done specifically for flail or grossly unstable elbows. Most cases followed distal humeral nonunion or trauma, with a few rheumatoid patients. It asks whether a linked implant can restore a stable, functional elbow when instability, not pain, is the primary problem.
When you see a flail or grossly unstable elbow from distal humeral nonunion, trauma, or rheumatoid destruction, the decision rule hinges on age and bone stock. Patients over 60, or younger patients with exhausted bone stock, multiple failed operations, or rheumatoid disease, are candidates for a linked semiconstrained total elbow arthroplasty rather than repeat ORIF, arthrodesis, or allograft.
The key mechanical concept: the Coonrad-Morrey anterior flange reestablishes the axis of rotation relative to the olecranon fossa and provides rotational stability, so missing epicondyles do not preclude a stable reconstruction. This is why custom implants and epicondylar reconstruction were unnecessary.
The tradeoff is a low-demand implant. Two ulnar components fractured during heavy activity, which is why these patients must be counseled to avoid high loads. Under 60 with adequate bone stock, still favor ORIF with autogenous grafting to preserve native joint.