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. 2021 Nov 12;2(1):96-102.
doi: 10.1016/j.xrrt.2021.10.001. eCollection 2022 Feb.

Nonoperative treatment of distal humerus fractures in the elderly yields satisfactory functional outcomes and low conversion to delayed surgery: a systematic review

Suleiman Y Sudah  1 , Richard N Puzzitiello  2 , Matthew H Nasra  3 , Michael A Moverman  2 , Nicholas R Pagani  2 , Michael S Guss  4 , Mariano E Menendez  2
Affiliations

Nonoperative treatment of distal humerus fractures in the elderly yields satisfactory functional outcomes and low conversion to delayed surgery: a systematic review

Suleiman Y Sudah et al. JSES Rev Rep Tech. .

Abstract

Background: Distal humerus fractures (DHFs) pose a treatment challenge in elderly patients. We sought to systematically review and report the clinical outcomes of the nonoperative approach (eg, "bag of bones") for the treatment of these injuries and the rate of conversion to delayed surgery.

Methods: A comprehensive review of the literature using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines was conducted. Studies involving outcomes after nonoperative treatment of DHF in patients >65 years of age were included from 1985 to present. Data regarding patient age, DHF type, nonoperative treatment method, complications, conversion to delayed surgery, range of motion, union rate, and surgeon- and patient-reported outcome measures were extracted.

Results: A total of five studies met inclusion criteria (all level IV evidence), yielding a total of 143 patients (mean age: 73.5 years to 87.4 years) with 7.1 months to 55 months of follow-up. The mean Mayo Elbow Performance Index scores were good to excellent across several studies (range 83-93.1). Multiple studies reported good range of motion (mean arc of motion: 81 to 106 degrees) and low levels of upper extremity disability (mean Quick Disability of the Arm-Shoulder-Hand scores: 31.3 to 38.5) at the final follow-up. The rate of conversion to total elbow arthroplasty and operative fixation ranged from 0% to 7.5% and 0% to 5%, respectively.

Conclusion: Nonoperative management of distal humerus fractures in the elderly seems to be associated with acceptable functional outcomes and low rates of delayed surgery. This information is important for patient counseling and treatment decision-making.

Keywords: Conversion; Distal humerus fracture; Elderly; Geriatric; Nonoperative; Total elbow arthroplasty.

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Figures

Figure 1
Figure 1
Rate of conversion to delayed surgery (TEA or ORIF) after nonoperative management of DHF, with forest plot displaying effect size (ES) (conversion rate represented by diamonds) and 95% confidence intervals (CIs) (horizontal lines). TEA, total elbow arthroplasty; ORIF, open reduction internal fixation; DHF, distal humerus fracture.
Figure 2
Figure 2
Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) article search flow diagram.
See this image and copyright information in PMC

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