Osteosynthesis is the gold standard in most distal humerus fractures but in elderly patients, arthroplasty may be a better option. The aim of the study was to assess our results with total elbow arthroplasty after acute distal humerus fracture in the elderly. Retrospective study to evaluate clinical and functional results plus complications of all patients from our hospital with a total elbow arthroplasty performed for acute distal humeral fracture. 18 patients were included with a mean age of 77 years (63-87). The mean postoperative range of motion was 89º and the average MEPS and DASH score 80 and 26 respectively. There were 4 complications (22%) and no reoperations. Total elbow arthroplasty can be a good choice for distal humerus fracture, as long as they are indicated in patients with complex fractures, difficult to synthesize due to osteoporotic or severe comminution and with a low functional demand.