title: Total elbow arthroplasty in distal humeral nonunion: clinical and radiographic evaluation after a minimum follow-up of three years.
abstract: BACKGROUND
  Total elbow arthroplasties (TEAs) are usually indicated in chronic inflammatory arthropathies. This procedure has also recently been used in complex distal humeral fractures and nonunions in selected patients. This study analyzed the clinical and radiographic outcomes in patients treated for nonunions around the elbow region with a minimum follow-up of 3 years.
  
  
  METHODS
  Between May 2002 and June 2012, 20 patients affected with distal humeral nonunions were treated with TEA. All patients were assessed clinically using the Mayo Elbow Performance Score and radiographically to evaluate the positioning of the prosthetic components and signs of loosening. Statistical analyses were performed to investigate the presence of clinical and radiographic variables as predictive factors of poor functional outcomes.
  
  
  RESULTS
  The Mayo Elbow Performance Score of the affected arm improved significantly between the preoperative period and follow-up. Results were good or excellent in 90% of the patients even if a high rate of complications (30%) was encountered. The development of complications after surgery and stages II, III, and IV radiolucency, according to the Morrey criteria, were predictive factors of poor outcomes.
  
  
  CONCLUSIONS
  According to the satisfactory results observed in this study, TEA could be indicated in selected patients aged older than 70 years with low functional demands and affected with distal humeral nonunions in which obtaining a stable fixation is difficult.
authors.affiliation: Orthopaedic and Traumatologic Department, University of Parma, Parma, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Pogliacomi
authors.affiliation: Orthopaedic and Traumatologic Department, University of Parma, Parma, Italy. Electronic address: davide.aliani@gmail.com.
authors.forename: Davide
authors.initials: D
authors.lastname: Aliani
authors.affiliation: Shoulder and Elbow Unit, Rizzoli Orthopedic Institute, Bologna, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Cavaciocchi
authors.affiliation: Orthopaedic and Traumatologic Department, University of Parma, Parma, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Corradi
authors.affiliation: Orthopaedic and Traumatologic Department, University of Parma, Parma, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Ceccarelli
authors.affiliation: Shoulder and Elbow Unit, Rizzoli Orthopedic Institute, Bologna, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Rotini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057929:Arthroplasty, Replacement, Elbow / Q000379:methods*; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013997:Time Factors; D016896:Treatment Outcome; D000092464:Elbow Injuries
keywords: Elbow; arthroplasty; distal humerus; evaluation; nonunion; treatment