Distal humerus fractures in patients over 65: Complications - 31/10/13

Doi : 10.1016/j.otsr.2013.10.002

L. Obert ^a,^⁎ , M. Ferrier ^a, A. Jacquot ^b, P. Mansat ^c, F. Sirveaux ^b, P. Clavert ^d, J.-L. Charissoux ^e, L. Pidhorz ^f, T. Fabre ^g
Société Française de Chirurgie Orthopédique et Traumatologie (SOFCOT)^h
^a Chirurgie orthopédique, traumatologique et plastique, centre hospitalier de Besançon, 2, boulevard Fleming, 25030 Besançon, France
^b Service d’orthopédie-traumatologie, centre chirurgical E.-Galle, 49, rue Hermite, 54000 Nancy, France
^c Institut de l’appareil locomoteur, centre hospitalier universitaire de Toulouse, place du Dr-Baylac, 31059 Toulouse, France
^d Centre de chirurgie orthopédique et de la main, 10, avenue Achille Baumann, 67400 Illkirch Graffenstaden, France
^e Département d’orthopédie-traumatologie, CHU Dupuytren, 2, avenue Martin Luther King, 87042 Limoges cedex, France
^f Service de traumatologie, chirurgie orthopédique, centre hospitalier Le Mans, 194, avenue Rubillard, 72037 Le Mans, France
^g Service d’orthopédie-traumatologie, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France
^h 56, rue Boissonnade, 75014 Paris, France

^⁎Corresponding author. Tel.: +03 81 66 82 42; fax: +03 81 66 93 06.

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En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Thursday 31 October 2013
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Summary

Introduction

Fractures of the distal humerus in patients over the age of 65 remain a therapeutic challenge. Treatment options include conservative treatment, internal fixation or total elbow arthroplasty. The complications of these different treatment options were evaluated in a multicentre study.

Materials and methods

Four hundred and ninety-seven medical records were evaluated. A retrospective study was performed in 410 cases: 34 received conservative treatment, 289 internal fixation and 87 underwent total elbow arthroplasty. A prospective study was performed in 87 cases: 22 received conservative treatment, 53 internal fixation, and 12 underwent total elbow arthroplasty. Patients were evaluated after at least 6 months follow-up.

Results

The rate of complications was 30% in the retrospective study and 29% in the prospective study. The rate of complications in the conservative treatment group was 60%, and the main complication was essentially malunion. The rate of complications was 44% in the internal fixation group and included neuropathies, mechanical failure or wound dehiscence. Although complications only developed in 23% of total elbow arthroplasties, they were often more severe than those following other treatments.

Discussion

Complications develop in one out of three patients over 65 with distal humerus fractures. Three main types of complications were identified. Neuropathies especially of the ulnar nerve, especially during arthroplasty, must always be identified, the nerve requiring isolation and transposition. Bone complications, due principally to mechanical failure, were found following internal fixation. Despite technical progress, care must be taken not to favor excessive utilization of this treatment option in complex fractures on fragile bone. Although there were relatively fewer complications with total elbow arthroplasty they were more difficult to treat. Ossifications were frequent whatever the surgical option and can jeopardize the functional outcome.