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Clin Shoulder Elb > Volume 15(2); 2012 > Article
Clinics in Shoulder and Elbow 2012;15(2):130-137.
DOI:    Published online December 31, 2012.
Clinical Outcome after Surgical Treatment of Intra-articular Comminuted Fracture of the Distal Humerus in the Elderly: Open Reduction and Internal Fixation Versus Total Elbow Arthroplasty
Doo Sup Kim, Yeu Seung Yoon, Chang Ho Yi, Ju Hyung Woo, Jung Ho Rah
Department of Orthopedic Surgery, Wonju Christian Hospital, Yonsei University, Wonju, Korea.
고령의 상완골 원위부 관절내 분쇄골절의 수술적 치료: 관혈적 정복술 및 내고정술과 일차적 주관절 전치환술의 임상적 결과
연세대학교 원주기독병원 정형외과학교실
To evaluate and report the clinical outcome after surgical treatment of intra-articular comminuted fracture of distal humerus in the elderly with osteoporosis. MATERIALS AND METHODS: From January 2007 to October 2009, 24 patients aged older than 65 years with intra-articular comminuted fracture of distal humerus underwent surgical treatment. 18 patients (Group I) were managed using primary open reduction and internal fixation (OR IF) through the modified posterior approach and 6 patients (Group II) were taken primary total elbow arthroplasty. The average follow up period was 17.2 months. According to the AO classification, there were 8 C2, 16 C3 type fractures. All enrolled patients were evaluated radiographically and clinically. Clinical outcomes were assessed with the Mayo Elbow Performance, Disabilities of Arm and Shoulder and Hand, and Musculoskeletal Functional Assessment functional questionnaires.
The bony union was observed in 18 patients in group I at average 14 weeks. There were 2 patients with neurapraxia of whom the ulnar nerve symptom did not improve despite of anterior transposition. And non-union at osteotomy sites was seen in 2 patients. The mean Mayo Elbow Performance score was 87.0. The mean DASH score was 32.4. The average arc of elbow flexion was 121.0degrees (range, 95~145degrees) with mean flexion-contracture of 12.0degrees (range, 0 to 35). 6 patients in Group II showed no complication during follow up periods. The mean Mayo Elbow Performance score was 89.1. The mean DASH score was 44.3. The average arc of elbow flexion was 125.1degrees (range, 100~145degrees) with mean flexion-contracture of 12.6degrees (range, 0 to 30).
With careful patient selection, Total elbow arthroplasty as well as OR IF could achieve good outcomes in elderly of comminuted intra-articular distal humerus fracture with osteoporosis.
Key Words: Distal humerus; Comminuted fracture; Osteoporosis; Open reduction and internal fixation; Total elbow arthroplasty
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