Distal humerus fractures in elderly patients: results after open reduction and internal fixation.
OBJECTIVE
Fractures of the distal humerus are difficult to treat. In elderly patients, diminished bone mineral quality and increased trauma-associated joint destruction may make stable joint reconstruction even more problematic. Furthermore, comorbidities and poor tolerance of joint immobilization might be additional factors which influence elbow function negatively. Until now, disagreement has existed on how to treat these fractures in elderly patients. Recommendations range from conservative treatment to primary total elbow replacement. So far, reports in the literature on whether or not open reduction and internal fixation in these patients is justified are very rare.


OBJECTIVE
To analyze fracture patterns, surgical approach, complications, and functional results after open reduction and internal fixation in patients of age 60 years and older.


METHODS
Retrospective clinical study of two university level 1 trauma centers, including 45 patients (median age 73 years; range, 61-92 years) with surgically treated distal humerus fractures. Fracture patterns were recorded according to their AO classification. All patients were treated by open reduction and internal fixation. A clinical and radiological follow-up was obtained after a minimum of 24 months following surgery (median 87 months; range, 24-121 months). Functional results were evaluated according to the Mayo Elbow Score.


RESULTS
Fractures with complete joint involvement were seen most often. Taking the fracture type into consideration, functional results deteriorated with degree of joint involvement. Postoperative complication rate was high, predominantly seen as screw loosening and/or implant failure at the lateral column. Neverthless, functional results were preponderating good or excellent. Factors negatively influencing outcome were joint immobilization longer than 14 days and severe joint involvement.


CONCLUSIONS
In elderly patients, distal humerus fractures, which are often considered "osteoporotic fractures," still remain one of the most demanding challenges in trauma surgery. The present study demonstrates that despite diminished bone quality and a high complication rate, open reduction and internal fixation in elderly patients is justified.


CONCLUSIONS
Open reduction and internal fixation of distal humerus fractures in elderly patients should be the main goal, since good elbow function can be achieved in the majority of patients. Elbow immobilization longer than 14 days should be avoided. Stable implant anchorage at the lateral column remains problematic, reflecting a general potential for further implant improvements.
Korner
Jan
J
Department for Trauma Surgery, Johannes Gutenberg-University Mainz, Germany. Jan.Korner@aofoundation.org
Lill
Helmut
H
Müller
Lars Peter
LP
Hessmann
Martin
M
Kopf
Klaus
K
Goldhahn
Jörg
J
Gonschorek
Oliver
O
Josten
Christoph
C
Rommens
Pol Maria
PM
D000368:Aged; D000369:Aged, 80 and over; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000503:physiopathology; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006811:Humerus / Q000000981:diagnostic imaging; D007592:Joint Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology; D011475:Prosthesis Failure; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D016896:Treatment Outcome