title: Functional outcomes of distal humeral fractures managed nonoperatively in medically unwell and lower-demand elderly patients.
abstract: BACKGROUND
  There is scant contemporary literature describing the outcomes of nonoperative management of distal humeral fractures. The aim of this study was to report the functional and radiographic outcomes after nonoperative management of distal humeral fractures.
  
  
  METHODS
  Between 2007 and 2013, 32 low-demand, medically unwell, or older patients with distal humeral fractures were treated nonoperatively. At the time of this study, 8 patients had died of unrelated causes, and 5 patients were lost to follow-up. The remaining 19 patients, with a mean age of 77 years, were available for a comprehensive assessment.
  
  
  RESULTS
  At a mean of 27 ± 14 months of follow-up, 68% (13 of 19) of patients reported good to excellent subjective outcomes. Outcomes in 2 patients were classified as poor, one of whom underwent total elbow arthroplasty as a result. Overall, the mean score on the Patient Rated Elbow Evaluation was 16 ± 23 and the Mayo Elbow Performance Index was 90 ± 11. When the injured was compared with the uninjured side, extension (22° ± 11° vs 8° ± 12°; P = .025) and flexion (128° ± 16° vs 142° ± 7°; P = .002) were significantly worse in the injured elbows. The fracture union rate was 81% (22 of 27) at a mean radiographic follow-up of 12 months.
  
  
  CONCLUSIONS
  Satisfactory outcomes were observed after the nonoperative management of selected distal humeral fractures in lower-demand, medically unwell, or older patients. Fracture union can be expected in most patients. In the uncommon instance when an unsatisfactory outcome occurs, successful salvage can be achieved with conversion to a total elbow arthroplasty.
authors.affiliation: Division of Orthopedic Surgery, Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Centre, University of Western Ontario, London, ON, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Desloges
authors.affiliation: Division of Orthopedic Surgery, Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Centre, University of Western Ontario, London, ON, Canada.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Faber
authors.affiliation: Division of Orthopedic Surgery, Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Centre, University of Western Ontario, London, ON, Canada.
authors.forename: Graham J W
authors.initials: GJ
authors.lastname: King
authors.affiliation: Division of Orthopedic Surgery, Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Centre, University of Western Ontario, London, ON, Canada. Electronic address: gathwal@uwo.ca.
authors.forename: George S
authors.initials: GS
authors.lastname: Athwal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002370:Casts, Surgical; D005260:Female; D017102:Fracture Healing; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D011859:Radiography; D013165:Splints
keywords: Distal humerus fractures; ORIF; elbow; elderly; functional outcomes; nonoperative; trauma