Elbow hemiarthroplasty using a “triceps-on” approach for the management of acute distal humeral fractures

Current concepts in elbow arthroplasty

“…One major difference between these two procedures is that extensive proximal ulna visualisation needed for TEA is not required with elbow HA, making triceps-on approaches more attractive if the distal humerus fracture allows. These approaches have produced excellent early-term range of motion and patient-reported outcome data 8 without reported extensor mechanism complications as described previously with triceps-off approaches. 9-11 Olecranon osteotomy can be used if the epicondyles are intact; which allows for great exposure, but also comes with major drawbacks including potential for posterior ulnohumeral joint malalignment, more complicated further revision of elbow HA to TEA, prominent ORIF hardware requiring revision, as well as a small risk of nonunion.…”

“…8-11 Although the Latitude EV is convertable to TEA with only ulnar component revision, there are no reports of patients undergoing this conversion to date. Evaluation in the long-term of this prosthesis system will necessary to determine the efficacy and appropriate use criteria for this device as a hemi-arthroplasty potentially in younger, more active patients.…”

A muscle sparing posterior approach to the elbow joint for total elbow arthroplasty

“…This technique had the advantage of preserving the entire muscle in continuity but carries the risk of ulnar neuropathies due to extensive mobilization and traction on the nerve during surgery (10 of the 80 TEA carried out by Morrey et al had ulnar neuropathies). 1 Oizumi et al 8 reported a satisfactory 42-month follow-up of 25 elbows with a triceps sparing Journal of Orthopaedic Surgery 25 (1) ulnar approach similar to Morrey et al Phadnis et al 9 have reported excellent results of the similar triceps-on technique for hemiarthroplasty of the elbow in humeral fractures. The difference between our technique and that of Celli 10 is that the author raised the lateral half of the insertion of triceps, which was not needed in our cases.…”

Arthroplasty in Elbow Fracture Treatment

“…All in all the outcomes of about 130 patients have been reported in English journals but no long-term follow-up results are available. (Burkhart et al 2011, Adolfsson and Nestorson 2012, Smith and Hughes 2013, Hohman et al 2014, Heijink et al 2015, Nestorson et al 2015, Phadnis et al 2015, Smith et al 2016, Schultzel et al 2017.…”

“…To date, there are 113 cases reported in English publications where an anatomically designed hemi-arthroplasty has been used in the primary treatment of distal humeral fracture (Burkhart et al 2011, Argintar et al 2012, Smith and Hughes 2013, Hohman et al 2014 , Phadnis et al 2015, Schultzel et al 2017. As yet no long-term follow-up results have been made available, we await these with great interest to see to what extent prosthetic loosening and wear of the olecranon are issues.…”