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Osteoporos Int (2005) 16: S73S79 DOI 10.1007/s00198-004-1764-5
ORIGINAL ARTICLE
Distal humerus fractures in elderly patients: results after open reduction and internal xation
Jan Korner Helmut Lill Lars Peter Muller Martin Hessmann Klaus Kopf Jrg Goldhahn Oliver Gonschorek Christoph Josten Pol Maria Rommens
Received: 21 July 2004 / Accepted: 22 July 2004 / Published online: 29 October 2004 International Osteoporosis Foundation and National Osteoporosis Foundation 2004
Abstract Problem: Fractures of the distal humerus are dicult to treat. In elderly patients, diminished bone mineral quality and increased trauma-associated joint destruction may make stable joint reconstruction even more problematic. Furthermore, comorbidities and poor tolerance of joint immobilization might be additional factors which inuence elbow function negatively. Until now, disagreement has existed on how to treat these fractures in elderly patients. Recommendations range from conservative treatment to primary total elbow replacement. So far, reports in the literature on whether or not open reduction and internal xation in these patients is justied are very rare. Aim of the study: To analyze fracture patterns, surgical approach, complications, and functional results after open reduction and internal xation in patients of age 60 years and older. Patients and methods: Retrospective clinical study of two university level 1 trauma centers, including 45 patients (median age 73 years; range, 6192 years) with surgically treated distal humerus fractures. Fracture patterns were recorded according to their AO classication. All patients were treated by open reduction and internal xation. A clinical and radiological follow-up was obtained after a minimum of 24 months following surgery (median 87 months; range, 24121 months). Functional results were evaluated according to the Mayo Elbow Score. Results: Fractures with complete
joint involvement were seen most often. Taking the fracture type into consideration, functional results deteriorated with degree of joint involvement. Postoperative complication rate was high, predominantly seen as screw loosening and/or implant failure at the lateral column. Neverthless, functional results were preponderating good or excellent. Factors negatively inuencing outcome were joint immobilization longer than 14 days and severe joint involvement. Discussion: In elderly patients, distal humerus fractures, which are often considered osteoporotic fractures, still remain one of the most demanding challenges in trauma surgery. The present study demonstrates that despite diminished bone quality and a high complication rate, open reduction and internal xation...