Distal humerus prosthetic hemiarthroplasty: midterm results

Abstract

Treatment of comminuted distal humeral fractures remains challenging. Open reduction-internal fixation remains the preferred treatment, but is not always feasible. In selected cases with non-reconstructable or highly comminuted fractures, total elbow arthroplasty has been used, however, also with relatively high complication and failure rates. Distal humerus prosthetic hemiarthroplasty (DHA) may be an alternative in these cases. The purpose of this study was to report the midterm results of six patients that were treated by DHA for acute and salvage treatment of non-reconstructable fractures of the distal humerus. All six patients were treated by DHA for acute and salvage treatment of non-reconstructable fractures of the distal humerus. Medical records were reviewed, and each patient was seen in the office. Mean follow-up was 54 months (range 21-76 months). Implant survival was 100 %. Three were pain free and three had mild or moderate residual pain. Average flexion-extension arc was 95.8° (range 70°-115°) and average pronation-supination arc was 165° (range 150°-180°). In three, there was some degree of instability, which was symptomatic in one. One had motoric and sensory sequelae of a partially recovered traumatic ulnar nerve lesion. According to the Mayo Elbow Performance Score, there were three excellent, one good and two poor results. Four were satisfied with the final result, and two were not. In this case series of six patients with DHA for non-reconstructable distal humerus fractures, favorable midterm follow-up results were seen; however, complications were also observed.

Keywords: Arthroplasty; Elbow; Posttraumatic; Replacement; Trauma; Upper extremity.

Fig. 1

Humeral component with anatomical spool (i.e., distal humerus prosthesis) of the Lattitude^® Total Elbow

Fig. 2

a–d Antero-posterior and lateral radiographic images of the elbow before (a, b) and at end follow-up (c, d) 43 months after distal humerus prosthetic hemiarthroplasty (humeral component of Latitude^® Total Elbow with anatomical spool) at end follow-up of case 6. The prosthesis is well positioned, without signs of loosening

Fig. 3

a–d Antero-posterior and lateral radiographic image of the elbow before (a, b) and at end follow-up (c, d) 61 months after distal humerus prosthetic hemiarthroplasty (humeral component of Latitude^® Total Elbow with anatomical spool) of case 2. Subluxations of the ulnohumeral joint and discrete irregularity of the articulating surface of the proximal ulna are noted