Total elbow arthroplasty and anatomic hemi-arthroplasty for distal humerus fractures

Total elbow arthroplasty (TEA) is the first-choice indication in low-demand elderly patients affected by distal humerus fractures (DHF) in which severe osteopenia and comminution make osteosynthesis impossible. The main advantages include the possibility of leaving the extensor mechanism intact, the shorter operative time and the easier functional recovery compared with internal fixation. Overall. good long-term outcomes are reported in terms of both pain relief and function. However, complications and implant failure requiring revision surgery may occur and patients must comply with certain limitations to extend the longevity of their implant. The development of the latest generation of TEA with convertible implants has led to increased interest in anatomic elbow hemiarthroplasty (EHA) for the treatment of some comminuted articular DHF with preserved condyles. Care should be taken to preserve and/or repair the collateral ligaments and columns to recover elbow stability. The main theoretical advantages of EHA over TEA are 1) the absence of polyethylene-induced osteolysis and 2) the absence of the hinge. which reduces the functional limitations in daily activities and is thus indicated in younger and more active patients. Short- to medium-term retrospective studies have reported promising results. However, higher quality evidence and longer-term results are needed to shed more light on EHA durability. The state of the art on elbow arthroplasties in DHF is described in this study, in which the indications, surgical technique peculiarities and the expected results are discussed.