Outcomes and complications of distal humeral hemiarthroplasty for distal humeral fractures – A systematic review

Abstract

Background Distal humeral hemiarthroplasty has been performed for a variety of indications with the most common being management of distal humeral fractures. This systematic review evaluates the outcomes and complications of distal humeral hemiarthroplasty for this pathology. Methods We searched PubMed, EMBASE, and MEDLINE for studies reporting indications and outcomes of patients undergoing distal humeral hemiarthroplasty. Study screening, risk of bias assessment, and data extraction were performed. Summery statistics were provided. Results We included 11 studies ( N = 163) in this review. In all studies, the indication for distal humeral hemiarthroplasty was the presence of an intraarticular, comminuted, unreconstructable fracture. The mean post-operative MEPS, FullDASH, and QuickDASH (SD) scores were 83.6 (6.1) points, 25.4 (10.3), and 15.7 (7.4) points, respectively. The mean post-operative range of motion (SD) was 106° (11°) in the flexion and extension arc and 153° (19°) in the protonation and supination arc. The overall rate of adverse events and complication was 63%. The rate for major complications was 11%. The mean total revision rate was 4% (0% to 15) and total re-operation rate was 29% (0% to 88%). Conclusion Distal humeral hemiarthroplasty is a suitable option for unreconstructable distal humeral fractures and offers good functional outcomes with acceptable complication rates.

A Novel Hemiarthroplasty Design for Treatment of Post-traumatic Elbow Ankylosis and Distal Humerus Nonunion

“…DHH recreates a functional ulnohumeral and radiocapitellar articulation, while avoiding the strict activity restriction and polyethylene wear of TEA. The procedure has also been shown to restore acceptable arcs of motion and MEPS scores in patients with unsalvageable injuries whom any attempt at fixation would be doomed for failure 11,20 .…”

“…DHH has been successfully used in the acute posttraumatic reconstruction and as a salvage procedure after failed fixation or after nonunion or malunion from operative or nonoperative management 5,[7][8][9][10] . With low revision rates reported in the literature and restoration of functional motion arcs, DHH shows promise as a salvage procedure with adequate outcomes and longevity 7,11 . When articular comminution precludes anatomic and stable reconstruction through internal fixation, DHH provides an excellent salvage solution that preserves elbow mobility and allows a lower level of functional restriction with allowance for higher demand than is advised in TEA 12,13 .…”

Hemiarthroplasty or total elbow arthroplasty for unreconstructable distal humeral fractures in patients aged over 65 years

“…Joint wear was reported in 26% of included cases, and similarly high rates have been reported in other systematic reviews. 53,54 Joint wear remains the most common challenge in HA. 55 The mean DASH in the HA group was 19.6 (SD 7.5), which appears to be substantially higher than that in the TEA group 38 (SD 11.9).…”

“…Joint wear was reported in 26% of included cases, and similarly high rates have been reported in other systematic reviews. 53,54 Joint wear remains the most common challenge in HA. 55…”

Massive bone defects due to infection at the surgical site associated with a distal humeral fracture that was treated using fibula autograft: a case report

“…Distal humerus fractures (DHFs) comprise between 2 and 5% of all fractures, and approximately one-third of all humerus fractures are of this type 1 , 2 . Following the global increase in the elderly population, the incidence of DHF is also increasing 3 .…”