Distal humerus fractures in patients older than age 60
Authors:
Radek Veselý; Martin Kelbl; Jan Kočiš; Ján Kužma; Tomáš Kočiš
Authors‘ workplace:
Traumatological Hospital Brno, Department of Traumatology, Faculty of Medicine Masaryk University Brno
; Úrazová nemocnice v Brně, Klinika traumatologie Lékařské fakulty Masarykovy univerzity Brno
Published in:
Úraz chir. 23., 2015, č.1
Overview
Objective:
A retrospective clinical evaluation of surgical treatment and complications after distal humeral fractures in patients older than age 60 treated by open reduction a internal fixation by two plates.
Material end methods:
Between January 2003 and December 2012 in the Traumatological hospital Brno we treated 145 patients by open reduction and internal fixation. In 116 patients, a clinical and radiological follow up was obtained after a minimum follow up of 18 months. The age distribution was from 61 to 89 with an average of 72 years Thirty-four patients were male, eighty-two female. Fracture types were classified according to the AO classification. Type C fractures documented in 74 cases, type B in 38 and extraarticular fractures type A were seen in 14 cases. For all type A and C was used dorsal approach. For type B was used dorsal or lateral approach. Extraarticular olecranon osteo-tomy was routinely performed in type C (66 patients). The functional results were evaluated by Mayo Elbow Score.
Results:
According Mayo Elbow Score we found 23 patients with excellent results, 44 patients with good, 34 with fair and 15 patients with poor results. An average score was 82 points (range, 43 to 100 points). The median arc of motion was 100° (range, 60 to 135°) of flexion and extension and 110° pronation - supination (range, 60–170°). In none of the patients ankylosis of the elbow was found. Postoperative complication rate was high, predominantly seen as implant failure or screw loosening (34 patients). In this study, there were nine non-unions, including four non-unions after olecranon osteotomy, requiring revision.
Conclusion:
Management of distal humerus fractures in elderly patients is still controversy. Severe comminution, bone loss and osteopenia predispose to unsatisfactory results. Over 30 % of such fractures develop significant complications during treatment. Standard surgical techniques are used for fixation of both columns, using a locking compression plates.
Key words:
Distal humerus fractures, plate osteosynthesis, locking compression plate, elderly patiens.
Sources
1. FRANKLE, MA., HERSOVICI, D. Jr., DIPASQUALE, TG. et al. A comparison of open reduction and internal fixation and primary total elbow arthroplasty in the treatment of intraarticular distal humerus fractures in women older than age 65. J Orthop Trauma. 2003, 17, 47–49. ISSN 0890-5339.
2. GALANO, GJ., AHMAD, CS., LEVINA, WN. Current treatment strategies for bicolumnar distal humerus fractures. J Am Acad Orthop Surg. 2010, 18, 20–30. ISSN 1067–1519.
3. GAMBIRASIO, R., RIAND, N., STERN, R. et al. Total elbow replacement for complex fractures of the distal humerus. J Bone Jt Surg Br. 2001, 83, 974–978. ISSN 0301-620X.
4. GEORGIADES, CH., MATĚJKA, J., PAVELKA, T. et al. Výsledky léčby zlomenin distálního humeru otevřenou repozicí a vnitřní fixací LCP. Acta Chir Orthop Traumatol Cech. 2010, 77, 479–483. ISSN 0001-5415.
5. GUSTILO, RB., ANDERSON, JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Jt Surg.1976, 58, 453–458. ISSN 0301-620X.
6. HOLDSWORTH, BJ., MOSSAD, MM. Fractures of the adult distal humerus, elbow function after internal fixation. J Bone Jt Surg Br. 1990, 72, 362–365. ISSN 0301-620X.
7. HOLUB, K., KLOUB, M., KOPAČKA, P. Zlomeniny distálního humeru AO 13 C – výsledky operační léčby. Acta Chir Orthop Traumatol Cech. 2012, 79, 529–534. ISSN 0001-5415.
8. ILYAS, AM., JUPITER, JB. Treatment of distal humerus fractures. Acta Chir Orthop Traumatol Cech. 2008, 75, 6–15. ISSN 0001-5415.
9. JOHN, H., ROSSO, R., NEFF, U. et al. Operative treatment of distal humeral fractures in the elderly. J Bone Jt Surg Br. 1994, 5, 793–796. ISSN 0301-620X.
10. KANIS, JA., CHRISTIANSEN, C., MELTON, J. et al. The diagnosis of osteoporosis. J Bone Miner Res. 1994, 9, 1137–1141. ISSN 0884-0431.
11. KINZL, L., FLEISCHMANN, W. The treatment of distal upper arm fractures. Unfallchirurg. 1991, 9, 455–460. ISSN 0177-5537.
12. KOCHER, M., MELCHER, GA., LEUTENEGGER, A. et al. Elbow fractures in eldery patients. Swiss Surg. 1997, 4, 167–171. ISSN 1023-9332.
13. KORNER, J., LILL, H., HEPP, P. et al. Spontaneous bone remodelling in complex distal humerus fracture with extensive osseous defect. J Orthop Trauma. 2004, 10, 700–705. ISSN 0890-5339.
14. KUNDEL, K., BRAUN, W., RUTER, A. Distal intra-articular humerus fractures in adults: results of surgical treatment. Unfallchirurg. 1992, 5, 219–223. ISSN 0177-5537.
15. MARCUS, R. The nature of osteoporosis. In: MARCUS, R., FELDMAN, D., KELSEY, J (eds). Osteoporosis. San Diego: Academic, 1996. 647–659.
16. MORREY, BF., AN, KN., CHAO, EY. Functional evaluation of the elbow. In: MORREY, B.F. (ed). The elbow and its disorders. 2nd ed, Philadelphia: Saunders, 1993. 86–97.
17. MULLER, LP., DIETZ, SO., ROMMENS, PM. et al. Total elbow replacement as primary treatment for complex fractures of the distal osteopenic humerus. Eur J Trauma. 2003, 29, 63–67. ISSN 1863-9933.
18. SANCHEZ – SOTELO, J., TORCHIA, ME., O´DRISCOLL, SW. Complex distal humeral fractures: Internal fixation with a principle-based parallel-plate technique. J Bone Joint Surg Am. 2007, 9, 961–969. ISSN 0021-9355.
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Surgery Traumatology Trauma surgeryArticle was published in
Trauma Surgery
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