Fixation of distal humeral fracture in elderly patient by locking compression plate

To review the outcomes of geriatric distal humeral fracture fixed with locking compression plate (LCP).

From January 2005 to December 2007, 24 patients (20 females and 4 males) with distal humeral fracture underwent open reduction and internal fixation with LCP. Their average age was 75.5 years old, ranged from 60 to 93 years old. Fracture was caused by injury from fall in 22 cases, by traffic accident in 1 case, and by direct hit in 1 case. There were 12 cases of type A2, 2 cases of type A3, 2 cases of type B1, 2 cases of type C1, 2 cases of type C2, 4 cases of type C3 fractures according to AO/ASIF classification. X-ray films in AP and lateral view were taken preoperatively. CT scan with three dimensional reconstructions was done in more comminuted fracture only. Open reduction with triceps sparing technique was used in all except type B fracture, and olecranon osteotomy was considered only in more comminuted C3 fracture. The average interval between injury and operation was 3 days (range, 1-6 days). Outcome measures included pain assessment, range of motion, and Mayo elbow performance score and findings at 1 year follow-up.

The average length of follow-up was 25 months (range, 12-48 months). All 24 fractures were healed within 6 months with an average of about 4 months. At 1 year follow-up, 83% (n = 20) of patients felt no pain and 17% (n = 4) of patients had mild pain; 83% of patient can gain a flexion range of more than 100 degrees; according to Mayo elbow performance score, the mean scores of type A, B and C fracture groups were 97, 85, and 89, respectively, and the post-operative performance of type A fracture was significantly better than that of type B and C (P = 0.034). Four patients had postoperative complications.

Open reduction and internal fixation of geriatric distal humeral fracture can achieve relatively good functional result and bony union despite of age.