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Distal humerus fractures in patients over 65: complications
L Obert1, M Ferrier, A Jacquot
1Chirurgie orthopédique, traumatologique et plastique, centre hospitalier de Besançon, 2, boulevard Fleming, 25030 Besançon, France.
Orthopaedics & Traumatology, Surgery & Research : OTSR
|November 5, 2013
Summary
Distal humerus fractures in older adults present challenges. Complications occur in about one-third of patients, with varying severity depending on treatment: conservative, internal fixation, or total elbow arthroplasty.
Area of Science:
- Orthopedic surgery
- Geriatric trauma
- Surgical outcomes
Background:
- Distal humerus fractures in patients over 65 are complex to treat.
- Treatment options include conservative management, internal fixation, and total elbow arthroplasty.
- Evaluating complications across these treatment modalities is crucial.
Purpose of the Study:
- To compare complication rates and types for different treatments of distal humerus fractures in elderly patients.
- To identify specific complications associated with conservative treatment, internal fixation, and total elbow arthroplasty.
Main Methods:
- A multicenter study involving retrospective and prospective evaluations.
- Analysis of 497 medical records (410 retrospective, 87 prospective).
- Follow-up of patients for at least 6 months post-treatment.
Main Results:
- Overall complication rates were similar in retrospective (30%) and prospective (29%) studies.
- Conservative treatment had a 60% complication rate, primarily malunion.
- Internal fixation showed a 44% complication rate (neuropathies, mechanical failure, wound dehiscence); total elbow arthroplasty had 23% but more severe complications.
Conclusions:
- One in three patients over 65 with distal humerus fractures experience complications.
- Key complications include ulnar nerve neuropathies (especially with arthroplasty), bone issues from mechanical failure (internal fixation), and frequent ossifications impacting function.
- While total elbow arthroplasty has fewer complications, they are more challenging to manage. Careful consideration is needed for internal fixation in fragile bone.
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