Abstract:

BACKGROUND: In young patients, open reduction and internal fixation with plate fixation are advantageous which yields 65%-100% good and excellent results. Due to osteoporosis and poor whole-body condition, whether elderty patients need internal fixation of metallic implants is not clear. 
OBJECTIVE: To investigate the treatment outcome of fractures of distal humerus using plate and to compare the treatment outcome with that of treated non-surgically or young patients. 
METHODS: From January 2002 to June 2006, 27 elderly patients with distal humerus fracture treated in the First Department of Orthopaedics, Yijisan Hospital, Wannan Medical College were recruited. Their mean age was 68 years (60-78 years). Open reduction and internal fixation were performed in 20 cases. Seven elbows were treated nonoperatively. Patients were followed up at 3, 6, and 12 weeks, the clinical and radiologic assessments were graded to evaluate the function of the elbow, articular step and the angle of distal humeral tilt. The outcomes were compared with those from the young patient treated with internal fixation.
RESULTS AND CONCLUSION: All the cases were followed up for 7 to 28 months. Bony union occurred in 26 cases, 1 case suffered aseptic nonunion. The patient refused the additional treatment for poor whole body condition. No implants broke. Though the screws of 2 cases and the k-wires of 3 cases were loosing, it was not necessary for further operation. The function of the elbow, articular step and the angle of distal humeral tilt of the surgically treated group were obviously superior to the non-surgically group (P < 0.01). Rates of complications of the elder treated surgically were observed to be comparable to those described in the literature for younger patients. There was no difference about the rates of the nonunion (including fracture site and olecranon osteotomy site), infection, heterotopic ossification nerve injury and the symptoms related with implants. Similar to the other intra-articular fracture, the internal fixation is beneficial for the distal humerus fracture in elderly patients as the angle the humerus tilt and integrity of the articuli were restored with the basic principle of surgery and inter fixation.