Intraarticular distal fractures of the humerus in old aged patients

Abstract

Treatment of intraarticular distal humeral fractures often leads to unsatisfying results mainly due to remaining limitation of active motion or pain. In aged patients this situation is aggravated by osteoporosis and multimorbidity.We review a series of intraarticular distal humeral fractures in twenty-nine patients aged over 80 during a period of ten years. 19 of these patients underwent surgery, the others were treated by closed reduction and cast fixation.After a mean follow-up of 2.6 years (0.8 to 9.0) the results of 20 patients were classified according to the scales by Caja and Cassebaum. Although the elbow function scores in operated patients were better compared to non-operatively treated patients (mean Caja-scale 71.4 points versus 65.0 points), some serious complications occurred, i.e. one case of implant failure due to repetitive falls. In one patient a total elbow prosthesis had to be implanted after intraoperative failure of the planned ORIF procedure.In the majority of patients treated by non-operative means (7 out of 10) a stationary admission could be avoided, leaving them in their accustomed social environment.The authors conclude that only in case of severe osteoporosis and multimorbidity closed reduction and cast fixation is an acceptable alternative to surgery.