McKee TEA vs ORIF distal humerus

A multicenter, prospective, randomized, controlled trial of open reduction--internal fixation versus total elbow arthroplasty for displaced intra-articular distal humeral fractures in elderly patients.

McKee MD, Veillette CJ, Hall JA, et al. Journal of shoulder and elbow surgery 2009 · PMID 18823799 · doi:10.1016/j.jse.2008.06.005

Question

In older patients with displaced intra-articular distal humerus fractures, does primary total elbow arthroplasty give better outcomes than ORIF?

Design

Multicentre randomised controlled trial in Canada.

Patients

Patients over 65 with displaced, intra-articular (comminuted) distal humeral fractures.

Intervention

Primary semi-constrained total elbow arthroplasty

Comparison

Open reduction and internal fixation with plates

Primary outcome

Mayo Elbow Performance Score at 2 years

Key result

TEA gave significantly better Mayo scores and shorter operations, and several ORIF patients were converted intraoperatively to TEA because fixation was not achievable.

Limitations

Small trial with short follow-up; TEA carries lifelong lifting restrictions and long-term revision risk not captured.

Impact on practice

Supports primary TEA (or hemiarthroplasty) as a valid option for unfixable distal humerus fractures in low-demand older patients.