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Unreconstructable distal humerus fractures in older adults can be treated with total elbow arthroplasty or elbow hemiarthroplasty, but comparative evidence has been limited. This multicentre randomized trial compared the two approaches in patients aged 60 years or older with fractures that could not be reliably reconstructed. At two years, functional outcomes were good and broadly similar in both groups, including DASH and Mayo Elbow Performance scores. The study suggests that hemiarthroplasty may be a credible alternative to total elbow replacement in carefully selected patients, potentially avoiding some of the constraints associated with a linked total prosthesis. However, implant selection must take into account ligament integrity, fracture pattern, bone stock and the patient's expected activity level. The sample was relatively small, so the findings should not be interpreted as proof that one procedure is always superior. For HCPs, the key practical message is that treatment planning should focus on reconstructability and elbow stability. When fixation cannot provide a reliable construct, arthroplasty becomes reasonable; within arthroplasty, both hemiarthroplasty and total replacement may have a role depending on the anatomy and surgeon expertise.
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Unreconstructable distal humerus fractures in older adults can be treated with total elbow arthroplasty or elbow hemiarthroplasty, but comparative evidence has been limited. This multicentre randomized trial compared the two approaches in patients aged 60 years or older with fractures that could not be reliably reconstructed. At two years, functional outcomes were good and broadly similar in both groups, including DASH and Mayo Elbow Performance scores. The study suggests that hemiarthroplasty may be a credible alternative to total elbow replacement in carefully selected patients, potentially avoiding some of the constraints associated with a linked total prosthesis. However, implant selection must take into account ligament integrity, fracture pattern, bone stock and the patient's expected activity level. The sample was relatively small, so the findings should not be interpreted as proof that one procedure is always superior. For HCPs, the key practical message is that treatment planning should focus on reconstructability and elbow stability. When fixation cannot provide a reliable construct, arthroplasty becomes reasonable; within arthroplasty, both hemiarthroplasty and total replacement may have a role depending on the anatomy and surgeon expertise.
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