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Distal Humeral Hemiarthroplasty
Although developments in open reduction and internal fixation (ORIF) and total elbow arthroplasty (TEA) have advanced the management of distal humeral fracture, there are clinical situations in which neither technique is optimal, such as when there is extensive joint comminution, when the entire articular surface is involved and ORIF cannot provide reliable outcomes, or for patients who have physical demands that exceed those allowed after TEA with an alternative for a stable functional elbow. The decision to perform distal humeral hemiarthroplasty is based on the general advantages of the procedure compared with ORIF and TEA as well as patient-specific lifestyle factors and functional status. DHH eliminates the risks of nonunion, malunion, loss of fixation, and stiffness associated with ORIF and the risk of polyethylene wear associated with TEA. In addition, DHH is not subject to a lifetime 6.6-lb (3-kg) weight-bearing restriction and has a lower incidence of component loosening compared with TEA, which makes it a more suitable choice for healthy, high-demand patients. This chapter reviews the indications for and contraindications to distal humeral hemiarthroplasty, and describes safe and effective methods for performing distal humeral hemiarthroplasty while limiting potential adverse events.