Distal humerus hemiarthroplasty: surgical technique

Distal humerus hemiarthroplasty (DHH) is a recent therapeutic option for the treatment of some acute unreconstructable humeral fractures, for the salvage of sequelae related to non-operative management or failed internal humeral fixation as well as in other rare pathological conditions. Standard anterior-posterior and lateral view X-rays and a CT scans are mandatory for an adequate preoperative planning. The main osseous and soft tissue stabilizers of the elbow should be intact or at least reparable because elbow stability is mandatory to be able to perform a DHH; in addition, both the medial and lateral columns should be either intact or reconstructable to guarantee an adequate soft tissue reinsertion and healing. This chapter aims to describe in detail the surgical technique of DHH. In particular the choice of the articular spool size, the orientation of the flexion-extension axis, and the reconstruction of soft tissue stabilizers represent the main key points for an optimal implantation.