title: Functional outcome after open reduction internal fixation of intra-articular fractures of the distal humerus in the elderly.
abstract: OBJECTIVE
  We conducted a study to evaluate the functional outcomes of elderly patients after open reduction internal fixation of intra-articular distal humerus fractures.
  
  
  METHODS
  Retrospective clinical and radiographic evaluation.
  
  
  METHODS
  A Level I trauma and tertiary referral center.
  
  
  METHODS
  We identified 23 eligible patients aged older than 65 years from the center's orthopaedic trauma registry between 1997 and 2005. Fourteen patients were available for follow-up. We had a mean follow-up of 51 months with a range of 20 to 99 months.
  
  
  METHODS
  All enrolled patients were acutely treated with open reduction internal fixation of their distal humerus.
  
  
  METHODS
  All enrolled patients were contacted and evaluated radiographically and with physical examination. Functional outcome was assessed with the Mayo Elbow Performance, Disabilities of Arm and Shoulder and Hand, and Musculoskeletal Functional Assessment functional questionnaires.
  
  
  RESULTS
  All 14 fractures united. The mean Mayo Elbow Performance score was 83. The mean elbow flexion-extension arc was 20° to 120°. There was no significant loss of forearm pronation-supination (P > 0.05) or grip strength (32.6 versus 34.0 lbs, P > 0.05) compared with the contralateral arm. The mean Disabilities of Arm and Shoulder and Hand score was 37.6. Musculoskeletal Functional Assessment scores demonstrated disability with a mean total score of 33.4 (normative 9.3), hand score of 34.7 (normative 3.7), and self-care score of 31.8 (normative 1.7). One patient required reoperation for a disabling flexion contracture.
  
  
  CONCLUSIONS
  Intra-articular distal humerus fractures are severely disabling injuries, particularly in the elderly population. Good results can be achieved with stable fixation and fracture union. Despite reasonable range of motion, patient-directed questionnaires revealed persistent pain and functional limitations.
authors.affiliation: Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA 98105, USA. jihuang@u.washington.edu
authors.forename: Jerry I
authors.initials: JI
authors.lastname: Huang
authors.forename: Michael
authors.initials: M
authors.lastname: Paczas
authors.forename: Harry A
authors.initials: HA
authors.lastname: Hoyen
authors.forename: Heather A
authors.initials: HA
authors.lastname: Vallier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D017102:Fracture Healing; D018460:Fractures, Comminuted / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D057072:Intra-Articular Fractures / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D008297:Male; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D014193:Trauma Centers; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D000092464:Elbow Injuries