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The Bone & Joint Journal
Vol. 97-B, Issue 8 | Pages 1132 - 1138
1 Aug 2015
Aitken SA Jenkins PJ Rymaszewski L

The best method of managing a fracture of the distal humerus in a frail low-demand patient with osteoporotic bone remains controversial. Total elbow arthroplasty (TEA) has been recommended for patients in whom open reduction and internal fixation (ORIF) is not possible. Conservative methods of treatment, including the ‘bag of bones’ technique (acceptance of displacement of the bony fragments and early mobilisation), are now rarely considered as they are believed to give a poor functional result.

We reviewed 40 elderly and low-demand patients (aged 50 to 93 years, 72% women) with a fracture of the distal humerus who had been treated conservatively at our hospital between March 2008 and December 2013, and assessed their short- and medium-term functional outcome.

In the short-term, the mean Broberg and Morrey score improved from 42 points (poor; 23 to 80) at six weeks after injury to 67 points (fair; 40 to 88) by three months.

In the medium-term, surviving patients (n = 20) had a mean Oxford elbow score of 30 points (7 to 48) at four years and a mean Disabilities of the Arm, Shoulder and Hand score of 38 points (0 to 75): 95% reported a functional range of elbow flexion. The cumulative rate of fracture union at one year was 53%. The mortality at five years approached 40%.

Conservative management of a fracture of the distal humerus in a low-demand patient only gives a modest functional result, but avoids the substantial surgical risks associated with primary ORIF or TEA.

Cite this article: Bone Joint J 2015;97-B:1132–8.


The Journal of Bone & Joint Surgery British Volume
Vol. 75-B, Issue 4 | Pages 572 - 576
1 Jul 1993
Knight D Rymaszewski L Amis A Miller J

Compression testing of cadaver specimens showed that excision of the radial head allowed proximal radial displacement. The insertion of a metallic radial head restored normal mechanics, while a silicone rubber implant did not. We reviewed 31 of 36 comminuted fractures of the radial head, 21 associated with dislocation or ulnar fracture, which had been treated by primary replacement with a Vitallium prosthesis. At a mean follow-up of 4.5 years, there was reliable restoration of stability and prevention of proximal radial migration. There had been no dislocations or prosthetic failures, but two implants had been removed for loosening. The prosthesis is recommended for use as a spacer to stabilise the elbow after severe injuries while the soft tissues heal.


The Journal of Bone & Joint Surgery British Volume
Vol. 70-B, Issue 3 | Pages 492 - 492
1 May 1988
Rymaszewski L Robb J


The Journal of Bone & Joint Surgery British Volume
Vol. 70-B, Issue 3 | Pages 489 - 489
1 May 1988
Robb J Rymaszewski L Reeves B Lacey C


The Journal of Bone & Joint Surgery British Volume
Vol. 66-B, Issue 1 | Pages 89 - 92
1 Jan 1984
Rymaszewski L Caullay J

Eight cases of unstable fractures caused by sharp heavy weapons such as swords or machetes are presented. A modern approach to these injuries is described against the historical background.


The Journal of Bone & Joint Surgery British Volume
Vol. 66-B, Issue 1 | Pages 109 - 113
1 Jan 1984
Rymaszewski L Mackay I Amis A Miller J

The effects of synovectomy and excision of the radial head in 40 elbows affected by rheumatoid arthritis have been assessed. In contrast with many reports indicating minimal side-effects of this procedure, a common pattern of deterioration from what was often a satisfactory initial result has been demonstrated. A biomechanical theory of one of the factors responsible for failure has been put forward and the importance of conserving or replacing the radial head emphasised.


The Journal of Bone & Joint Surgery British Volume
Vol. 64-B, Issue 4 | Pages 405 - 408
1 Aug 1982
Jepson K Nada A Rymaszewski L