Hemiarthroplasty of the distal humerus for acute and chronic complex intra-articular injuries

Background: Comminuted intra-articular distal humeral fractures represent a challenging upper extremity injury. This study reviews clinical and radiographic results in patients with distal humeral hemiarthroplasty (DHH). Methods: DHH with the Latitude prosthesis (Tornier, Saint-Ismier, France) was performed in 8 patients (mean age, 64 years; age range, 33-75 years) for unreconstructible fractures of the distal humerus or salvage of failed internal fixation. Clinical outcomes were assessed with the American Shoulder and Elbow Surgeons elbow instrument; Mayo Elbow Performance Index; and Disabilities of the Arm, Shoulder and Hand questionnaire at a mean of 36 months. Radiologic assessment included radiographs and computed tomography to evaluate olecranon wear and densitometry (dual-energy x-ray absorptiometry). Range of motion, pain, and elbow satisfaction were recorded, and descriptive statistics were used for analysis. Results: Seven patients were available to participate in the follow-up examination. Acute cases (5 patients) scored better than salvage cases (2 patients) on the Mayo Elbow Performance Score (80 points [range, 67-95 points] and 65 points [range, 50-80 points], respectively) and Disabilities of the Arm, Shoulder and Hand score (31 points [range, 2.5-68 points] and 39 points [range, 17-62 points], respectively). The mean arc of elbow flexion and extension was 96 degrees (range, 70 degrees-130 degrees), with mean flexion of 120 degrees (range, 90 degrees-135 degrees) and a mean extension loss of 19 degrees (range, 5 degrees-30 degrees). The mean arc of forearm rotation was 160 degrees (range, 140 degrees-180 degrees). Reoperation was required in 4 patients because of painful retained hardware. Five patients reported pain with activities of daily living. Conclusion: DHH should be used with caution until such time as longer-term outcome studies are able to show the efficacy of this procedure. (C) 2014 Journal of Shoulder and Elbow Surgery Board of Trustees.