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Functional outcome after open reduction internal fixation of intra-articular fractures of the distal humerus in the elderly.
Journal of Orthopaedic Trauma 2011 May
OBJECTIVE: We conducted a study to evaluate the functional outcomes of elderly patients after open reduction internal fixation of intra-articular distal humerus fractures.
DESIGN: Retrospective clinical and radiographic evaluation.
SETTING: A Level I trauma and tertiary referral center.
PATIENTS/PARTICIPANTS: We identified 23 eligible patients aged older than 65 years from the center's orthopaedic trauma registry between 1997 and 2005. Fourteen patients were available for follow-up. We had a mean follow-up of 51 months with a range of 20 to 99 months.
INTERVENTION: All enrolled patients were acutely treated with open reduction internal fixation of their distal humerus.
MAIN OUTCOME MEASUREMENTS: All enrolled patients were contacted and evaluated radiographically and with physical examination. Functional outcome was assessed with the Mayo Elbow Performance, Disabilities of Arm and Shoulder and Hand, and Musculoskeletal Functional Assessment functional questionnaires.
RESULTS: All 14 fractures united. The mean Mayo Elbow Performance score was 83. The mean elbow flexion-extension arc was 20° to 120°. There was no significant loss of forearm pronation-supination (P > 0.05) or grip strength (32.6 versus 34.0 lbs, P > 0.05) compared with the contralateral arm. The mean Disabilities of Arm and Shoulder and Hand score was 37.6. Musculoskeletal Functional Assessment scores demonstrated disability with a mean total score of 33.4 (normative 9.3), hand score of 34.7 (normative 3.7), and self-care score of 31.8 (normative 1.7). One patient required reoperation for a disabling flexion contracture.
CONCLUSIONS: Intra-articular distal humerus fractures are severely disabling injuries, particularly in the elderly population. Good results can be achieved with stable fixation and fracture union. Despite reasonable range of motion, patient-directed questionnaires revealed persistent pain and functional limitations.
DESIGN: Retrospective clinical and radiographic evaluation.
SETTING: A Level I trauma and tertiary referral center.
PATIENTS/PARTICIPANTS: We identified 23 eligible patients aged older than 65 years from the center's orthopaedic trauma registry between 1997 and 2005. Fourteen patients were available for follow-up. We had a mean follow-up of 51 months with a range of 20 to 99 months.
INTERVENTION: All enrolled patients were acutely treated with open reduction internal fixation of their distal humerus.
MAIN OUTCOME MEASUREMENTS: All enrolled patients were contacted and evaluated radiographically and with physical examination. Functional outcome was assessed with the Mayo Elbow Performance, Disabilities of Arm and Shoulder and Hand, and Musculoskeletal Functional Assessment functional questionnaires.
RESULTS: All 14 fractures united. The mean Mayo Elbow Performance score was 83. The mean elbow flexion-extension arc was 20° to 120°. There was no significant loss of forearm pronation-supination (P > 0.05) or grip strength (32.6 versus 34.0 lbs, P > 0.05) compared with the contralateral arm. The mean Disabilities of Arm and Shoulder and Hand score was 37.6. Musculoskeletal Functional Assessment scores demonstrated disability with a mean total score of 33.4 (normative 9.3), hand score of 34.7 (normative 3.7), and self-care score of 31.8 (normative 1.7). One patient required reoperation for a disabling flexion contracture.
CONCLUSIONS: Intra-articular distal humerus fractures are severely disabling injuries, particularly in the elderly population. Good results can be achieved with stable fixation and fracture union. Despite reasonable range of motion, patient-directed questionnaires revealed persistent pain and functional limitations.
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