[Intra-articular fracture of the distal humerus: outcome after osteosynthesis in patients over 60]

This is a retrospective analysis of patients aged over 60 years treated in a single center for intra-articular fractures of the distal humerus. Outcomes were compared with published results for osteosynthesis and arthroplasty.

The cohort included 34 patients (36 fractures) reviewed at mean 35 months. Mean age was 77.6 years. Fracture types were: C1: 8, C2: 10, C3: 18. The transtricipital posteromedial approach was used in the majority of patients. Fixation was achieved with a prebent lateral plate (n=11 fractures), a Y-plate (n=9), two plates (n=4), pins or screws (n=9) and an external fixator (n=3). Outcome was assessed with the Mayo elbow score, the Bröberg radiographic score and patient satisfaction. The social impact was also noted.

The mean Mayo elbow score was 73.3; outcome was excellent (n=13), good (n=8), fair (n=5) and poor (n=10). Pain persisted in 23 patients. The mean range of movement was 80 degrees . Patient satisfaction remained good. Ten patients did not recover their preoperative level of autonomy. Radiological signs of osteoarthritis were noted for 75% of patients and nonunion of the humeral fracture in 32%. There were three superficial infections and four neurological lesions.

Good and very good outcome was noted for 59% of the osteosyntheses in this series, compared with 71% in the literature. The rate for arthroplasty is 95%. The mean range of motion is 101 degrees , 17% of patients with a prosthesis complain of pain, 5% develop a superficial infection and 6.5% suffer neurological injury. The estimated rate of revision for arthroplasty is 11% at 7 years.

Beyond the age of 65 years and based on evidence reported in the literature, it would be advisable to prefer another mode of treatment for these intra-articular fractures, for example elbow arthroplasty, particularly for comminutive fractures on osteoporotic bone.