Elbow hemiarthroplasty for unreconstructible distal humerus fractures: a case series

Abstract

Background: To evaluate the outcomes of distal humerus hemiarthroplasty (DHH) in a series of eight consecutive patients with unreconstructible distal humeral fractures or failed open reduction and internal fixation (ORIF).

Methods: Retrospective data including demographics, postoperative outcomes, and complications were extracted from electronic records at a level 1 trauma center. Surgeries were performed by a single fellowship-trained upper extremity surgeon. The indications for DHH were unreconstructible distal humerus fracture or failed ORIF. Eventually, as accepted by current literature, no weight restrictions were applied. Range of motion (ROM), functional scores, and pain levels were evaluated during follow-up appointments. Minimum follow-up time was 12 months.

Results: Between 2014 and 2024, eight consecutive patients underwent DHH. The mean patient age at the time of surgery was 68.1 years, with an average follow-up of 46.6 months. Patients exhibited satisfactory ROM, with near-complete pronosupination and mean flexion and extension of 125° and 25°, respectively. Functional scores, including Quick Disabilities of the Arm, Shoulder and Hand score (35.2) and Mayo Elbow Performance Score (78.1), were good. Mean Numeric Pain Rating Scale was 3.9. Complications included two conversions to total elbow arthroplasty due to elbow instability and postoperative infection (staged conversion), one ligament reconstruction for postoperative elbow instability, two cases of ulnar periprosthetic fracture, and one case of ulnar nerve neuropathy.

Conclusions: DHH for unreconstructible distal humerus fractures and failed ORIF allows for unrestricted postoperative lifting and yields satisfactory functional outcomes but does have a relatively high complication rate. Level of evidence: IV.

Keywords: Complications; Distal humerus fractures; Functional outcomes; Mayo Elbow Performance Score; Elbow hemiarthroplasty.

Fig. 1.

Radiographs and computed tomography images of patient no. 6. (A-D) Fracture assessment radiographs and sagittal computed tomography reconstruction images showing AO Foundation/Orthopaedic Trauma Association (AO/OTA) 13B3.3 distal humerus fracture. (E, F) Early postoperative radiographs. (G, H) Last follow-up radiographs (28 months postoperatively) showing a well-fixed prosthesis.

Fig. 2.

Radiographs, computed tomography, intraoperative fluoroscopy, and images of patient no. 7. (A) Fracture assessment. (B, C) Intraoperative fluoroscopy during open reduction and internal fixation (ORIF). (D) Failure of primary ORIF. (E) Revision ORIF. (F) Failure of revision ORIF. (G, H) Intraoperative fluoroscopy of distal humerus hemiarthroplasty. (I) Distal humerus hemiarthroplasty postoperative radiograph. (J) Early postoperative dislocation. (K-M) Intraoperative and postoperative images and radiographs of ligament reconstruction. (N, O) Radiographs showing a nondisplaced fracture through the distal screw of the olecranon plate due to a traumatic fall. (P, Q) Radiographs (6 months post-ORIF) showing a periprosthetic ulnar fracture with clinical and radiographic union.