179. ELBOW HEMIARTHROPLASTY FOR DISTAL HUMERAL FRACTURES

Abstract

Purpose: This study reviews the early results of elbow hemiarthroplasty for distal humeral fractures.

Method: Elbow hemiarthroplasty was performed on 30 patients (mean 65 years; 29–91) for unreconstruc-table fractures of the distal humerus or salvage of failed internal fixation. A ‘triceps on’ approach was used in six and an olecranon osteotomy in 24. A Sorbie Questor prosthesis (Wright Medical Technology) was used in 14 patients and a Lattitude (Tornier) in 16. Clinical review at a mean of 25 months (3–88) included the American Shoulder and Elbow Surgeons elbow outcomes instrument (ASES), Mayo Elbow Performance Index (MEPI) and radiological assessment.

Results: At follow up of 28 patients mean flexion deformity was 25 degrees, flexion 128 degrees, range of pro-nosupination 165 degrees, mean ASES 83, MEPI 77 and satisfaction 8/10. Acute cases scored better than salvage cases. Re-operation was required in 16 patients (53%); two revisions to a linked prosthesis for periprosthetic fracture and aseptic loosening at 53 and 16 months, 12 metalwork removals and four ulnar nerve procedures. Posterolateral rotatory instability was present in one elbow, four had laxity and pain on loading (two with prosthesis or pin loosening), four had laxity associated with column fractures (two symptomatic) and ten had asymptomatic laxity only. The triceps on approach had worse laxity and clinical scores. Uncomplicated union occurred in all olecranon osteotomies and 86% of column fractures. One elbow had an incomplete cement mantle and seven had lucencies > 1 mm; one was loose but acceptable. Five prostheses were in slight varus and two were flexed. Two elbows had early degenerative changes and 15 developed an osteophytic lip on the medial trochlea.

Conclusion: Early results of elbow hemiarthroplasty show good outcomes after complex distal humeral fractures, despite a technically demanding procedure, met-alware removal in 40%, symptomatic laxity in 12% and column non-union in 8%. Better results are obtained for treatment in the acute setting and with use of an olecranon osteotomy.