Functional outcomes and complications of distal humerus hemiarthroplasty performed in acute versus salvage cases: a systematic meta-analysis

Background: Distal humeral hemiarthroplasty (DHH) is a treatment option for comminuted joint fractures of the elbow, particularly when osteosynthesis is not possible or has failed. This meta-analysis aims to compare the clinical and functional outcomes of DHH performed for distal humerus fractures acutely versus as salvage after failure of osteosynthesis (open reduction and internal fixation [ORIF]). Methods: A systematic review was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Studies reporting cases of DHH for complex distal humerus fractures were included and grouped according to the surgical context: acute (initial fracture) or salvage (ORIF failure). The variables analyzed included functional scores (Mayo Elbow Performance Score, Disabilities of the Arm, Shoulder and Hand), joint range of motion (flexion, extension, pronation-supination), complication rates, reoperation rates, and revision rates. Comparisons were performed using random-effects meta-analysis. Results: Eighteen studies totaling 583 patients (547 acute; 36 salvage) met inclusion. Functional scores were comparable between groups (Mayo Elbow Performance Score, 86 vs. 83; Disabilities of the Arm, Shoulder and Hand, 16.7 vs. 17.3). Pooled complication rates were 26.5% in acute cases and 19.3% in salvage cases; between-group differences were not statistically significant in our meta-analytic comparison. Conclusion: DHH offers comparable functional outcomes and similar complication rates whether performed acutely or as salvage after failed ORIF. Prospective and adequately powered comparative studies are needed to refine indications and quantify risks.