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Complications and Functional Outcomes after Transolecranon Distal Humerus Fracture.

OBJECTIVE: Transolecranon distal humerus fractures are uncommon injuries. This is the first multi-patient case series to describe outcomes and complications following transolecranon distal humerus fractures in the adult population.

DESIGN: Retrospective SETTING: Single Level 1 Trauma Center PATIENTS/PARTICIPANTS: 16 patients INTERVENTION: Surgical management of transolecranon distal humerus fracture MAIN OUTCOME MEASUREMENT: Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire after minimum of 12 months RESULTS: 16 patients with open (n=12) or closed (n=4) transolecranon distal humerus fractures were identified. 9 female and 7 male patients with a mean age of 47 years were included. Mechanisms of injury included motor vehicle collisions (n=3), motorcycle crashes (n=4), ground level falls (n=3), falls from height (n=4), train collision (n=1), and an industrial accident (n=1). 44% (n=7) presented with nerve injury. Patients underwent open reduction with internal fixation (n=15), external fixation (n=6), or both (n=5). Additional surgeries were ultimately required in 69% of patients (n=11), with a mean of 3 surgeries to manage each patient's elbow injuries. All patients returned for at least 3 clinical follow-up visits; mean clinical follow-up was 15.8 months and mean radiographic follow-up was 12.3 months. Complications were observed in 94% (n=15) of patients. 69% (n=11) had limited range of motion with a flexion arc of less than 100 degrees at their last clinic visit. 44% (n=7) developed deep wound infections requiring repeat débridement and IV antibiotics. Implant removal was performed in 62.5% (n=10) due to infection (n=5), symptomatic hardware (n=4), or device failure (n=1). Heterotopic ossification was seen in 50% (n=8), and post-traumatic arthrosis in 25% (n=4). 12.5% (n=2) of patients required flap reconstruction for soft tissue defects. Nonunion occurred in 44% of patients (n=7). DASH scores were obtained for 62.5% (n=10) of patients at a mean of 3.8 years after injury. The mean DASH score was 40.2, ranging from 4.2 to 76.5. Among respondents, 70% (n=7) were able to resume working, with an average DASH work module score of 25.

CONCLUSION: Management of transolecranon distal humerus fractures remain a challenge for orthopedic surgeons. Complication rates, including deep infection and nonunion, are high, with frequent long-term functional limitations posed to the patient, as evidenced by DASH scores.

LEVEL OF EVIDENCE: Level IV; Case Series; Treatment Study.

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