Functional Results of Communited Intra-articular Distal Humerus Fractures Treated with Bicolumnar Plating

Communited intra-articular distal humerus fractures are commonly encountered in orthopaedic practice and they are present with unique difficulties for internal fixation. This problem is especially worse in the elderly due to osteoporotic bone.

To evaluate the intermediate term results (minimum follow up of two years) of communited intra-articular distal humerus fractures treated with bicolumnar plating with or without olecranon osteotomy in elderly Indian population.

Sixty three consecutive patients operated with bicolumnar plating for communited intra-articular distal humerus fractures at the tertiary care centre were identified in the time period between 2009 and 2013. All patients had an age more than 60 years at the time of surgery. A minimum follow up of two years post surgery was a mandatory criteria. The Disabilities of Arm and Shoulder and Hand (DASH) score and the Mayo Elbow Performance (MEP) score calculated along with complete range of motion.

The mean follow-up was 38 months. All patients achieved fracture union with mean MEP and DASH scores being 85 ± 15.5 and 21.4 ± 4.9 respectively. These scores although poor were comparable to the opposite side (90 and 12.2 respectively). Also the mean supination-pronation arc and flexion-extension arc was 156 degrees and 105 degrees respectively. This is well within the functional range of elbow. The mean block to extension was at 15 degrees with a mean maximal flexion of 120 degrees.

Our study conclusively establishes that excellent functional outcome can be achieved with open reduction and internal fixation in Type C distal humerus fractures in elderly including the ones that are communited. Total elbow arthroplasty although a viable option, gives similar results to a well done internal fixation with added cost.