Distal humerus fracture in the elderly: does conservative treatment still have a role?

Abstract

Introduction: Conservative treatment is exceptional in fracture of the distal extremity of the humerus in patients over 65 years of age. In a selected population, however, it may be an attractive option.

Materials and methods: One prospective and one retrospective study included a total of 56 patients, with a mean age of 84.7 years (range, 68-100 yrs). All were managed by 6 to 8 weeks' brachial-antebrachial-palmar immobilization, without fracture reduction. Fractures were AO type A in 18 cases, type B in 8 cases and type C in 30 cases.

Results: At a mean 20.2 months' follow-up in the retrospective and 8.6 months in the prospective series, mean MEPS score was 83 and 86 points with 75% and 83% satisfactory results respectively and mean Quick-DASH 31.3 and 34.4 points respectively. There were 3 non-unions. There was extra-articular malunion in 70% and intra-articular malunion in 65% of cases in the retrospective series, versus 16% intra-articular malunion in the prospective series. The rate of osteoarthritis increased over time, with more than 50% grade 2 or 3 in the retrospective series at end of follow-up. There were 3 complications: 2 hematomas and 1 skin lesion (localized pressure ulcer). There were 3 fracture displacements, not requiring change in management.

Discussion: Conservative treatment for fracture of the distal extremity of the humerus in patients over 65 years of age is exceptional, but conserves patient's independence and provides satisfactory clinical results, with no significant joint stiffness or elbow instability. Non-anatomic results on X-ray, however, have to be accepted.

Keywords: Conservative treatment; Distal humerus fracture; Immobilization; Malunion; Osteoarthritis.