title: Treatment of distal humerus fractures with LCP DHP™ locking plates in patients older than 65 years.
abstract: BACKGROUND
  Fractures of the distal humerus are often complex and therefore challenging to treat. In elderly patients with decreased bone strength due to osteoporosis, strong fixation is crucial to allow resuming early motion that guarantees a good functional outcome as well as minimising mechanical complications. Locked implants meet these requirements. Here, we report outcomes in a uniform series of patients older than 65 years with distal humerus fractures managed with LCP DHP(®) (Synthès) fixation. Our objective was to evaluate the efficacy and limitations of this technique.
  
  
  OBJECTIVE
  LCP DHP provides strong fixation of osteoporotic bone and leads to good clinical and radiological outcomes.
  
  
  METHODS
  We retrospectively studied 46 consecutive patients (2004-2010) with a mean age of 80 years including 15 with extra-articular and 31 with articular distal humerus fractures. At presentation, 11 complications were noted in nine patients (compound fractures and trauma-related nerve injuries). The transolecranon approach was used in 31 patients. Mean duration of immobilisation was 2.7 weeks in 33 patients.
  
  
  RESULTS
  Forty-three patients were re-evaluated after a mean follow-up of 25 months (range, 10-64 months); two patients died and one was lost to follow-up. Flexion was 127° and loss of extension was 23°, producing an average range of motion of 104°. Functional recovery was highly satisfactory with a Mayo Clinic Performance Score of 87 (70-100) and 95% of good and very good results. Postoperative complications consisted of infection (n=3), metaphyseal non-union (n=2), ulnar nerve injury (n=6), transient radial nerve palsy (n=1), and peri-articular ossification (n=4). Compound fracture and worse AO fracture type were associated with worse functional outcomes.
  
  
  CONCLUSIONS
  Despite the high complication rate, functional recovery was similar to that reported in previous case series, including after arthroplasty. Furthermore, the rate of mechanical complications was lower. Thus, our working hypothesis was confirmed.
  
  
  METHODS
  Level IV retrospective non-comparative study.
authors: Department of Orthopaedic and Trauma Surgery, de Hautepierre Hospital, Strasbourg Academic Hospital Group, 1, avenue Molière, 67098 Strasbourg, France. guillaume.ducrot@chru-strasbourg.fr
authors: G
authors: G
authors: Ducrot
authors: F
authors: F
authors: Bonnomet
authors: P
authors: P
authors: Adam
authors: M
authors: M
authors: Ehlinger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D004867:Equipment Design; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D057072:Intra-Articular Fractures / Q000601:surgery*; D008297:Male; D011859:Radiography; D020127:Recovery of Function; D012189:Retrospective Studies; D016896:Treatment Outcome