[Distal intraarticular humerus fracture in the elderly: prosthesis or osteosynthesis?]

The distal intraarticular fracture of the humerus, even in elderly patients, was treated so far with internal osteosynthesis. Due to the poor bone stock, in association with a complex fracture site, the achieved results may be disappointing. The use of an elbow joint prosthesis may be a solution for these specific problems in elderly patients as long as one takes the features of the prosthesis into account.

Eleven patients with a mean age of 77 years were followed up for 12 months after implantation of an elbow joint replacement. In the other group we examined 15 patients (average age 73 years) after internal fixation for 20 months. Apart from radiological inspection, we applied the Mayo Elbow Score and documented all complications.

There were only type B or C fracture sites in this study. The applied osteosynthesis ranged from the classical bilateral plating with osteotomy of the olecranon to minimal invasive screwing or K-wire pinning with additional postoperative immobilisation. The averaged range of motion amounted to 57 degrees in the osteosynthesis group, compared with 89 degrees in the prosthesis group. In 8 cases we used the semiconstrained Coonrad-Morrey system, and 3 times a hemiprosthetic replacement of the fractured condyles by the Latitude prosthesis. The Mayo score of the group after prosthetic replacement reached 91 compared to merely 77 points in the group after osteosynthesis. After osteosynthesis we saw several major complications, including in 4 cases a partial implant failure with consecutive loss of reposition, 1 case of heterotopic ossification and 1 incomplete sensitive N. ulnaris disorder.

We recommend osteosynthetic management of type B fractures. The appropriate treatment of C-type fractures remains demanding and leads in cases of reduction malalignment with supportive immobilisation to poor results. Here the primarily implanted elbow prosthesis provides a safe solution for a painfree, stable and mobile joint.