Elbow hemiarthroplasty for intra-articular distal humerus fractures- best option for whom?

San Francisco, CA, USA: Elbow hemiarthroplasty using the humeral component of the total elbow arthroplasty is an option for treatment of isolated, comminuted distal humerus fractures in select patient populations, finds a new study. Some advantages of elbow hemiarthroplasty are a less-demanding operation and avoid complications associated with linked design including polyethylene wear, periprosthetic fracture, or implant loosening. Although to date the literature on elbow hemi arthroplasty is limited, recent renewed interest has demonstrated encouraging results.

The study has appeared in the  journal of shoulder and elbow surgery.

J.R. Taylor et al did a study to report results of elbow hemiarthroplasty for comminuted, intra-articular distal humerus fractures in low-demand elderly female patients.

The study included a retrospective case series of eight patients who underwent elbow hemiarthroplasty for comminuted, intra-articular distal humerus fractures between 2015 and 2019. Patients were considered for the procedure if the humeral fractures were deemed nonreconstructable by open reduction internal fixation. Patients were excluded if the extensor mechanism was not intact, evidence of significant ulnohumeral osteoarthritis, or a fracture to the proximal radius or ulna.

A "triceps-on" approach was used in all cases. Appropriate sizing of the spool and length of the implant were determined by intraoperative fluoroscopy. Both ulnar collateral ligament and the lateral ulnar collateral ligaments were repaired through the central spool after final placement of the implant. Postoperative radiographs, clinical data, and the Mayo Elbow Performance Score were used to assess elbow pain and function.

Results:

• Seven patients were included in final analysis. One patient was excluded from final analysis after sustaining a ground-level elbow dislocation at 13 weeks postoperatively, which subsequently revised to total elbow arthroplasty.

• The average age at the final follow-up was 72.1 years.

• The duration of follow-up was 29.9 months (range 11.4-58.8 months).

• Average elbow range of motion was 210 ± 150 extension, 1350 ± 90

flexion, 870 ± 50 pronation and 840 ± 80 supination.

• The average Mayo Elbow Performance Score was 88.3 (range 85-95; or "good" to "excellent") at the final follow-up.

• Postoperative ulnar neuropathy was reported by one patient at the first postoperative visit. This was followed up clinically and evaluation at 24 months revealed mild residual sensory deficits and adequate strength and motor function.

• To date, there have been no cases of subsidence, hardware loosening, or periprosthetic fracture on postoperative radiographs, no wound complications, instability events, or infection.

The authors concluded that -

The ideal candidates for elbow hemiarthroplasty are elderly, low-demand, and able to adhere to postoperative activity and weight bearing restrictions. Overall patient satisfaction with off-label use of humeral component of commercially available total elbow implants in the United States is promising. Accurate sizing of the native width of the distal humerus is difficult in setting of severe articular fracture comminution. Development of a more anatomic spool to better replicate the distal humeral articular surface, with multiple size options independent of the stem width is warranted.

Further reading:

Elbow hemiarthroplasty for intra-articular distal humerus fractures: results and technique.

J. Ryan Taylor, MD, MPH, Kelsey E. Shea, BA, Charles F. Clark, MD, James D. Kelly II, MD, Mark A. Schrumpf, MD

Journal of Shoulder & Elbow Surgery- Reviews, Reports, and Techniques 1 (2021) 408-413

https://doi.org/10.1016/j.xrrt.2021.08.002