Highlights
- •Open reduction internal fixation is sometimes impossible in distal humerus fractures in adults due to extensive comminution and bone loss.
- •Elbow Hemi-Arthroplasty (EHA) is a reasonable option for unreconstructible intra-articular distal humerus fractures in patients over the fifth decade.
- •The implant removes complications related to the ulnar component such as wear of the hinge or aseptic loosening of the ulnar component. It does bring potential disadvantages such as risk of instability with possible wear and progressive joint osteoarthrosis.
Abstract
The surgical management of distal humerus fractures in adults generally consists in
open reduction internal fixation (ORIF) or total elbow arthroplasty (TEA). Hemi humeral
hemiarthroplasty (EHA) is a treatment option for unreconstructable intra-articular
distal humerus fractures. It is a reasonable option in patients over the fifth decade
and its potential advantages are to eliminate the complications related to the ulnar
component such as wear of the hinge (busching wear) or the aspetic loosening of the
ulnar component. The potential disadvantages are the risk of instability with the
possibility of a wear and progressive joint osteoarthrosis. The aims of this manuscript
are to evaluate the indications in which we used the EHA, analyzing the correct surgical
technique and describe the outcomes in medium and long-term follow-ups. Between 2006
and 2019, we performed 51 EHAs at the Hesperia Hospital in Modena and at the Rizzoli
Orthopedic Institute. Taking into consideration only the cases of acute fractures,
27 patients (27 elbows) with a minimum follow-up of 12 months were identified. The
patient's mean age at the time of surgery was 64 years old (range from 45 to 78 years
old) and they were 78% female (21 out of 27). The Latitude Tornier implant was used
in all the patients of our group. The mean MEPS was 89.3 points (from 50 to 100 pts)
with excellent results in 19 patients, good in 5, one fair and 2 poor;the mean DASH
was 12.6 (from 3.3 to 45.8); the mean OES was 42.3 (from 22 to 47). Complications,
were found in 12 patients and any patients required a TEA conversion. Distal humerus
hemiarthroplasty from our experience is a good option for the surgical management
of unrecostructible distal humeral fractures in selected patients. It is important
to perform a precise surgical technique; preserve the triceps insertion, preserve
or repair the collateral ligaments, fix the condylar bones implant the prosthesis
at the correct size, depth and rotation. The majority of the complication that we
observed are related to the stiffness and no to the progressive degenerative changes
of the articular surface
Keywords
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Article info
Publication history
Published online: November 09, 2020
Accepted:
November 8,
2020
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
