Distal humerus hemiarthroplasty for complex intra-articular fractures in elderly or nonfixable patients: a meta-analysis of clinical and functional outcomes

Aims Distal humerus fractures are difficult to treat when fixation is not possible, particularly in elderly patients. While total elbow arthroplasty (TEA) is often used in elderly patients, it is generally not suitable for younger or more active individuals. Distal humerus hemiarthroplasty (DHH) may represent a viable alternative in selected cases. This systematic review and meta-analysis aimed to evaluate the clinical and functional outcomes of DHH in patients with complex distal humerus fractures. Methods A systematic review was conducted in accordance with PRISMA guidelines. PubMed, Embase, and Cochrane Library were searched up to January 2024. Studies reporting outcomes of DHH for distal humerus fractures were included. Functional scores, range of motion, complications, and revision rates were pooled using a random-effects meta-analysis. Subgroup analyses were performed according to fracture type (AO classification) and surgical approach (triceps-on vs triceps-off). Results Nineteen studies including 593 patients (mean age 68 years; mean follow-up 53 months) were analyzed. The pooled Mayo Elbow Performance Score (MEPS) was 84.7 [95% CI 80.8–88.5], and the DASH score was 20.8 [13.6–28.0]. The mean flexion-extension arc was 102° [97–106], and the pronation-supination arc was 155° [147–162]. The overall complication rate was 26.7% [18.3–37.1%], the reoperation rate 11.6% [5.3–23.4%], and the revision rate 3.4% [1.1–10.1%]. Subgroup analyses showed comparable outcomes across fracture types, but a significantly higher instability rate in type B3 fractures (p = 0.017). No significant differences were found between triceps-on and triceps-off approaches. Conclusion DHH yields satisfactory functional outcomes and range of motion in complex distal humerus fractures not amenable to fixation, particularly in elderly patients. However, a complication rate of 26.7% was observed. Careful patient selection remains essential, especially in fractures at high risk of postoperative instability.