title: Elbow hemiarthroplasty using a "triceps-on" approach for the management of acute distal humeral fractures.
abstract: BACKGROUND
  Total elbow arthroplasty is an established option for the primary treatment of acute distal humeral fractures, but there are sparse data regarding elbow hemiarthroplasty (EHA) as an alternative. We present the outcome of EHA performed with a modular anatomic prosthesis and a "triceps-on" surgical technique.
  
  
  METHODS
  Eighteen consecutive patients underwent EHA for an acute fracture. Two patients died, leaving a study group of 16 patients with minimum 2-year follow-up. Clinical evaluation included range of motion; Mayo Elbow Performance Score; Quick Disabilities of the Arm, Shoulder, and Hand score; and Oxford Elbow Score. Radiographic assessment looked at alignment, evidence of loosening, ulnar and radial head wear, heterotopic ossification, and whether healing of the condyles had occurred.
  
  
  RESULTS
  Mean follow-up was 35 months (24-79 months). The mean scores were as follows: Mayo Elbow Performance Score, 89.6; shortened Disabilities of the Arm, Shoulder, and Hand score, 11.2; and Oxford Elbow Score, 43.7. The mean flexion and pronation-supination arcs were 116° and 172° respectively. Radial head wear was absent in 13 patients and mild in 3. Ulnar wear was absent in 6 patients, mild in 8, and moderate in 2. Wear was not associated with greater pain or inferior functional scores. There was no sign of aseptic loosening, and complete condylar bone union occurred in 15 elbows. There was 1 complication, a transient ulnar nerve neurapraxia that resolved without intervention.
  
  
  CONCLUSIONS
  EHA with a modular anatomic implant using a triceps-on approach is a reliable technique for the management of acute unreconstructible distal humeral fractures in older patients.
authors.affiliation: Royal Surrey County Hospital, Guildford, UK. Electronic address: joideep@doctors.org.uk.
authors.forename: Joideep
authors.initials: J
authors.lastname: Phadnis
authors.affiliation: Albany Hospital, Albany, NY, USA.
authors.forename: Samik
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: Wrightington Hospital, Wigan, Lancashire, UK.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Watts
authors.affiliation: Department of Orthopaedic, Epsom and St Helier University Hospitals NHS Trust, Epsom, Surrey, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Little
authors.affiliation: Royal Surrey County Hospital, Guildford, Surrey, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Hearnden
authors.affiliation: Department of Orthopaedic, Epsom and St Helier University Hospitals NHS Trust, Epsom, Surrey, UK.
authors.forename: Vipul R
authors.initials: VR
authors.lastname: Patel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D004551:Elbow Joint / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D062785:Hemiarthroplasty / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D063868:Patient Outcome Assessment
keywords: Elbow; acute; distal humerus; fracture; hemiarthroplasty; outcomes; triceps-on