Elbow hemiarthroplasty for the management of distal humeral fractures: current technique, indications and results

Abstract

There has been a growing recent interest in the use of elbow hemiarthroplasty for the treatment of distal humeral trauma in select patients. However, the current available evidence regarding outcome after elbow hemiarthroplasty is limited to case series and biomechanical data. Consequently, the procedure remains unfamiliar to many surgeons. The aim of the present review is to outline the evidence regarding elbow hemiarthroplasty and to use this, along with the author's experience, to better describe the indications, surgical technique and outcomes after this procedure.

Keywords: arthroplasty; distal humerus; elbow; fracture; hemiarthroplasty; trauma.

Figures

Figure 1.

Triceps on surgical approach. The surgical approach has been completed, the articular fragments resected and the distal humerus prepared. A trial implant has been placed. The triceps remains attached to the olecranon and the triceps fascia has been split in continuity with the anconeus fascia on the lateral aspect of the olecranon. To gain access, the distal humerus has been subluxated laterally. Note the trochlea spool is overlying the radial head.

Figure 2.

Reconstruction of fractured condyles. (a) Drill holes made in medial and lateral condylar fragments. (b, c) 2-0 Fibre wire passed through cannulation in spool and pre-made drill holes, then whip-stitched into collateral ligaments. (d) Condyles reduced to implant and humeral columns and tied firmly to each other through the cannulated spool. (e, f) Condyles further secured with tension band sutures via drill holes and cerclage sutures to the implant.