A total elbow arthroplasty performed for fractures is an inherently stable construct as the humeral and ulnar components are linked. A potential disadvantage of this technique is the risk of stem loosening because of load transfer to the stem-cement-bone interface and polyethylene wear at the implant linkage. There are several total elbow arthroplasty systems available. Surgeons should refer to the manufacturer’s specific operative technique of their chosen implant for details. One system is illustrated in this procedure to demonstrate the generic techniques and principles. Compare implant size of the humeral trial spools with the patient’s native olecranon and radial head. The sizing of the spool determines the stem size to be used. For arthroplasty, access is needed to the whole distal humerus with additional access to the olecranon for total arthroplasty. In almost all distal humeral fractures, the roof of the olecranon fossa remains in continuity with the humeral shaft regardless of fracture comminution.

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