title: Distal humeral hemiarthroplasty: indications, results, and complications. A systematic review.
abstract: BACKGROUND
  Distal humeral hemiarthroplasty (DHH) is a treatment option for unreconstructable intra-articular distal humerus fractures. DHH may also be used in the setting of rheumatoid arthritis, orthopaedic tumor with significant bone loss, malunion, or osteomyelitis. DHH has specific advantages over other, more common, treatment modalities: total elbow arthroplasty (TEA) and open reduction internal fixation (ORIF). DHH is especially a reasonable option in younger patients to preserve bone stock, avoid significant weight restrictions, and limit loosening.
  
  
  METHODS
  The literature was reviewed for all cases of DHH for fracture and non-fracture indications between 1947 and 2014. Two hundred thirty-six papers were identified; 4 studies including 17 patients met criteria for non-fracture indications and 13 studies including 116 patients were identified for fracture indications. A systematic review was generated; patient indications, outcomes, and complications were recorded.
  
  
  RESULTS
  For non-fracture indications, good to excellent results were achieved in 76.5 % of patients with a mean arc of motion of 62° at mean follow up of 46.3 months. Half of the patients experienced a complication, most commonly stiffness. Loosening of the prosthesis was not noted in any patient. For fractures, good to excellent results were achieved in 67.4 % of patients with a mean arc of motion of 98.3° at a mean follow up of 42.2 months. One third of the patients experienced a complication but only 1.7 % experienced loosening of the prosthesis.
  
  
  CONCLUSIONS
  Here, we present the first review of the indications for DHH. DHH is a reasonable treatment option for older patients with unreconstructable intra-articular fractures of the distal humerus as well as younger patients with rheumatoid arthritis, orthopaedic tumor with significant bone loss, malunion, or osteomyelitis.
authors.affiliation: William Beaumont Army Medical Center, Department of Orthopaedic Surgery, 5005 N Piedras, Fort Bliss, TX 79920 USA.
authors.forename: John
authors.initials: J
authors.lastname: Dunn
authors.affiliation: William Beaumont Army Medical Center, Department of Orthopaedic Surgery, 5005 N Piedras, Fort Bliss, TX 79920 USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Kusnezov
authors.affiliation: Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center, 4800 Alberta Avenue, El Paso, TX 79920 USA.
authors.forename: Miguel
authors.initials: M
authors.lastname: Pirela-Cruz
keywords: Distal humerus fracture; Elbow arthroplasty; Rheumatoid arthritis