Mid-term outcomes of elbow hemiarthroplasty using the triceps-on approach for comminuted distal humerus fractures.

Background: There has been an increasing interest in elbow hemiarthroplasty to circumvent the problems with total elbow arthroplasty for comminuted distal humerus fractures in the elderly. The primary aim of the study is to assess the mid-term clinical and radiological outcomes of patients undergoing TEA and hemiarthroplasty for distal humerus fractures.

Methods: Retrospective analysis of data for patients undergoing hemiarthroplasty for distal humerus fractures (OTA- C3 Comminuted total articular fractures) was done. This is a non-randomized consecutive series from a single centre. A minimum follow-up of 3 years was required for inclusion. Patients with delayed/neglected presentation (>3 weeks), those needing total elbow arthroplasty and conservatively managed fractures needing delayed arthroplasty were excluded.

Results: A total of 12 patients were operated in the period between 2016 and 2021(mean follow-up-59.4 months). The mean age of the patients undergoing hemiarthroplasty was 68.4 years. The mean arc of flexion extension was 21-115°. The mean range of supination was 75° while pronation was 86° (p > 0.05). The mean QuickDASH score was 8.7. There were no cases of infection, dislocations, intra-operative fractures or revision surgery. Two patients had transient weakness in the ulnar nerve distribution that recovered on follow-up.Evidence of heterotrophic ossification was seen in 8 patients. None of the patients showed radiological evidence of loosening but trochlear cartilage wear was seen in 2 patients. None of the radiographs showed migration of the condyles. There were 5 cases where the medial condyle though approximated had not healed.

Conclusions: Elbow hemiarthroplasty provides predictably good clinical and radiological outcomes on mid-term follow-up. Longer follow-up is necessary to determine the survival of these prostheses in the long term.