Hemiarthroplasty for irreparable distal humeral fractures

Abstract

We report our experience of performing an elbow hemiarthroplasty in the treatment of comminuted distal humeral fractures in the elderly patients. A cohort of 42 patients (three men and 39 women, mean age 72; 56 to 84) were reviewed at a mean of 34.3 months (24 to 61) after surgery. Functional outcome was measured with the Mayo Elbow Performance Score (MEPS) and range of movement. The disabilities of the arm, shoulder and hand questionnaire (DASH) was used as a patient rated evaluation. Complications and ulnar nerve function were recorded. Plain radiographs were obtained to assess prosthetic loosening, olecranon wear and heterotopic bone formation. The mean extension deficit was 23.5° (0° to 60°) and mean flexion was 126.8° (90° to 145°) giving a mean arc of 105.5° (60° to 145°). The mean MEPS was 90 (50 to 100) and a mean DASH score of 20 (0 to 63). Four patients had additional surgery for limited range of movement and one for partial instability. One elbow was revised due to loosening, two patients had sensory ulnar nerve symptoms, and radiographic signs of mild olecranon wear was noted in five patients. Elbow hemiarthroplasty for comminuted intra-articular distal humeral fractures produces reliable medium-term results with functional outcome and complication rates, comparable with open reduction and internal fixation and total elbow arthroplasty.

Hemiarthroplasty for Distal Humerus Fracture: A Systematic Review and Meta-analysis for Functional Outcome

“…A total of 115 patients from the 9 articles were included in the study, most of whom were female (Table 1). 10,11,[15][16][17][18][19][20][21] Among the 9 included articles, 2 articles described 2 different implant systems (the Sorbie-Questor system and the Latitude system); based on the raw data of these articles, our analysis included only those cases where the Latitude system had been used.…”

“…Smith et al 16) Stiffness (1), aseptic loosening (2) 2015 Phadnis et al 17) Ulnar nerve neurapraxia (1), radial head wear (3), ulnar wear (10), heterotopic ossifications (11) 2015 Nestorson et al 18) Limited range of movement (4), partial instability (1), loosening (1), sensory ulnar nerve symptoms (2), mild olecranon wear (5) 2015 Heijink et al 19) Some degree of instability (3), motoric and sensory sequelae of a partially recovered traumatic ulnar nerve lesion (1)…”

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.…”

“…In our follow-up of 42 patients treated with primary hemiarthroplasty one patient had secondary surgery (reconstruction of the lateral ulnar collateral ligament) because of instability (Nestorson et al 2015).…”

“…Four patients had undergone secondary surgery (10%) prior to final follow-up because of restricted movement (Nestorson et al 2015). Abrams et al reported a 62% prevalence 6 months after surgery for an intra-articular elbow fracture, and 9% had had secondary surgery with removal of bone and arthrolysis (Abrams et al 2012).…”