Distal Humeral Hemiarthroplasty Versus Total Elbow Arthroplasty for Acute Distal Humeral Fractures

Abstract

For acute distal humeral fractures not amenable to open reduction and internal fixation, total elbow arthroplasty has become an established alternative. However, lifelong activity restrictions designed to prevent early mechanical failure make this a poor option for some patients. This has led to a renewed interest in distal humeral hemiarthroplasty. Using modern implants and techniques, distal humeral hemiarthroplasty has shown outcomes comparable to those of total elbow arthroplasty at short- to mid-term follow-up, with an overall higher but different complication rate. Long-term data are needed, but the available literature suggests that distal humeral hemiarthroplasty be considered as another option on the treatment spectrum in select patient populations. [Orthopedics. 2017; 40(1):13-23.].

Fracture-pattern-related therapy concepts in distal humeral fractures

“…Depending on the fracture pattern, it may be impossible to make a rigid construct allowing for early full range of motion [ 15 ]. In the case of a multifragmentary fracture type with a severely comminuted articular surface, low-plane fractures, or poor bone quality caused by osteoporosis or arthritis, arthroplasty can be considered [ 15 ]. Similar to other joints, hemiarthroplasty can be considered in distal humeral fractures.…”

“…It is mandatory to have a stable elbow joint with intact or reconstructable radial head, coronoid, and ulna in addition to intact or reconstructable collateral ligaments [ 15 – 17 ]. Therefore, the advantage of the reduced operative time mentioned in the literature is counteracted by the simple fact that the collateral ligaments are affected to a corresponding degree, leading to complex reconstruction with the challenge of correct tension [ 16 , 17 ]; especially since the unlinked nature of the hemiarthroplasty requires mandatory correct placement for stable kinematics [ 15 ]. Furthermore, mid- and long-term results are still missing and the impact of the implant on the ulnar and radial cartilage is unknown.…”

“…Generally, one can differentiate between linked models, which contain a linkage between the humeral and ulnar components, and unlinked models [ 15 ]. In the past, most linked total elbow arthroplasties (TEA) where constrained models with simple hinges that led to an excessive amount of shear stress with subsequent high rates of aseptic loosening and wear on the material and thus ultimate failure [ 15 ]. Modern TEA are semiconstrained with a sloppy hinge allowing for ±7° varus/valgus motion [ 19 ].…”

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

“…We found only one comparative systematic review of TEA versus distal humerus hemiarthroplasty, but the outcomes based on age and implant choice were not considered. 12) Thus, we aimed to analyze the clinical outcomes and complications associated with hemiarthroplasty using the single-implant system (the Latitude system) in distal humerus fractures through a systematic review of relevant literatures.…”

Arthroplasty in Elbow Fracture Treatment

“…A meta-analysis comparing total-vs hemi arthroplasty reported a higher incidence of second ary surgery after hemi arthroplasty, mainly due to the complications of olecranon osteotomy, but there were no significant differences in functional outcome at short-to medium-term follow-up (Rangarajan et al 2017). This was not confirmed in our own register-based study that showed no significant difference in revision rate or adverse events leading to secondary surgery (Nestorson et al, unpublished data, paper IV).…”