Outcomes of distal humerus fractures in patients above 65 years of age treated by plate fixation - 09/10/13

Doi : 10.1016/j.otsr.2013.08.001

P. Clavert ^a,^⁎ , G. Ducrot ^a, F. Sirveaux ^b, T. Fabre ^c, P. Mansat ^d
and
the SOFCOT^e
^a Service d’orthopédie-traumatologie, CHU de Strasbourg, avenue Baumann, 67400 Illkirch, France
^b Service d’orthopédie-traumatologie, centre de chirurgie Emile-Gallé, 49, rue Hermite, 54000 Nancy, France
^c Service d’orthopédie-traumatologie, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
^d Institut de l’appareil locomoteur, CHU de Toulouse, place du Dr-Baylac, 31059 Toulouse, France
^e Société française de chirurgie orthopédique et traumatologie, 56, rue Boissonnade, 75014 Paris, France

^⁎Corresponding author. Tel.: +33 3 88 55 21 51.

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Summary

Introduction

Distal humerus fractures in elderly patients are often complex fractures that are difficult to treat. The goal of this study was to report on the results of a multicentre series of internal fixation of AO type A, B and C distal humerus fractures in elderly patients and to identify the pros and cons of various fixation constructs.

Patients and methods

Two studies were performed. One was a prospective multicentre study with 53 patients and the other was a retrospective multicentre study with 289 patients, all above 65 years of age and with a recent distal humerus fracture. Patients were evaluated based on clinical criteria (history, health condition, joint range of motion, Mayo Elbow Performance Score) and radiological criteria (fracture type, union of fracture, presence of malunion, hardware condition).

Results

Based on the MEPS, the clinical and functional results were relatively satisfactory: average of 92 points for type A, 82 points for type B and 88 points for type C. In both series, type B fractures were the most difficult to treat and had less good clinical, functional and radiological outcomes. Most of the complications occurred with type C fractures; these consisted mainly of nerve injuries and fixation failure/non-union.

Discussion

Although these fractures are difficult to treat and have an appreciable number of complications, the functional recovery was fairly satisfactory. One of the most challenging aspects of surgical treatment is the existence of osteoporosis in these patients. This must be carefully analysed to determine if an indication exists for total elbow arthroplasty.