Treatment of distal humerus fractures in the elderly

Geriatric patients with osteopenic bone present unique challenges in the treatment of fractures of the distal humerus, and require different strategies from the traditional treatment philosophies. Fracture union, rather than motion, is the first priority, because motion can be restored reliably by subsequent contracture release, if necessary, as long as the fracture heals. Modifications in the surgical technique, combined with newer implants incorporating distal, transcondylar screws into the plate to improve distal fixation, may improve outcomes. The use of massive, tricortical autogenous bone grafts to replace very comminuted segments of the medial and lateral columns also is helpful. Finally, modification of olecranon osteotomy fixation will minimize healing and hardware problems at this site. For fractures that are judged intraoperatively not to be stable enough to commence early motion, the implementation of a short period of immobilization followed by early soft tissue release will avoid exposing the patient to the risk of nonunion, and result in a more predictable functional outcome.