Endoprosthetics of the elbow joint. When primary and when secondary?

Posttraumatic sequelae and severe articular fractures can cause a loss of function at the elbow joint. Principally, open reduction and internal fixation (ORIF) is the treatment of choice for acute fractures of the elbow. Despite custom made implants, osteosynthesis is not promising in some cases and elbow arthroplasty provides an alternative for the rapid restoration of elbow function in these patients. Failed osteosynthesis with nonunion of the bone or arthrosis can also be an indication for implantation of an elbow prosthesis. Semiconstrained prostheses must be used for stable treatment. Due to implant-associated complications and restrictions an unlimited recommendation for elbow arthroplasty cannot be made. The range of applications is limited in the face of possible loosening, frictional wear and especially due to the restricted weight carrying capacity of 2.5 kg recommended by the manufacturers. The investigation of essential criteria and their consideration represent a challenge for the physician in the context of the individual decision-making. This article provides an aid to decision-making taking individual factors into account and three exemplary cases are described to illustrate the procedure used by the authors.