Clin Should Elbow.  2012 Dec;15(2):130-137.

Clinical Outcome after Surgical Treatment of Intra-articular Comminuted Fracture of the Distal Humerus in the Elderly: Open Reduction and Internal Fixation Versus Total Elbow Arthroplasty

• Kim DS
• Yoon YS
• Yi CH
• Woo JH
• Rah JH

Abstract

PURPOSE
To evaluate and report the clinical outcome after surgical treatment of intra-articular comminuted fracture of distal humerus in the elderly with osteoporosis.
MATERIALS AND METHODS
From January 2007 to October 2009, 24 patients aged older than 65 years with intra-articular comminuted fracture of distal humerus underwent surgical treatment. 18 patients (Group I) were managed using primary open reduction and internal fixation (OR IF) through the modified posterior approach and 6 patients (Group II) were taken primary total elbow arthroplasty. The average follow up period was 17.2 months. According to the AO classification, there were 8 C2, 16 C3 type fractures. All enrolled patients were evaluated radiographically and clinically. Clinical outcomes were assessed with the Mayo Elbow Performance, Disabilities of Arm and Shoulder and Hand, and Musculoskeletal Functional Assessment functional questionnaires.
RESULTS
The bony union was observed in 18 patients in group I at average 14 weeks. There were 2 patients with neurapraxia of whom the ulnar nerve symptom did not improve despite of anterior transposition. And non-union at osteotomy sites was seen in 2 patients. The mean Mayo Elbow Performance score was 87.0. The mean DASH score was 32.4. The average arc of elbow flexion was 121.0degrees (range, 95~145degrees) with mean flexion-contracture of 12.0degrees (range, 0 to 35). 6 patients in Group II showed no complication during follow up periods. The mean Mayo Elbow Performance score was 89.1. The mean DASH score was 44.3. The average arc of elbow flexion was 125.1degrees (range, 100~145degrees) with mean flexion-contracture of 12.6degrees (range, 0 to 30).
CONCLUSIONS
With careful patient selection, Total elbow arthroplasty as well as OR IF could achieve good outcomes in elderly of comminuted intra-articular distal humerus fracture with osteoporosis.

MeSH Terms

Aged
Arm
Arthroplasty
Elbow
Follow-Up Studies
Fractures, Comminuted
Hand
Humans
Humerus
Osteoporosis
Osteotomy
Patient Selection
Shoulder
Ulnar Nerve