Abstract
An increasing number of distal humeral fractures are presenting as fragility fractures in low demand elderly patients. The optimal management of these injuries remains controversial. The primary aim of this study was to document the short and long term outcomes of these fractures treated with primary nonsurgical intervention. All patients were identified from a prospective trauma database from 1995 to 2010. All conservatively managed, isolated fractures of the distal humerus (OTA Type A,B,C) were included. Prospective long term follow up was collected by telephone interview. Demographic data, fracture classification, management protocol, subsequent surgeries, complications, range of motion, function and patient reported outcomes were recorded. The primary short-term outcome measure was the Broberg and Morrey Elbow Score. The primary long-term outcome measure was the DASH score.
Sixty-two patients were included. Mean age 76 (range, 11–96). Low-energy injuries were seen in 97% (59/61) of patients and ≥1 co-morbidities in 50% (27/54). At a mean of 3.7 months (range, 1–14) mean Broberg and Morrey score was 86 (range, 52–100); 70% (28/40) achieving excellent or good short-term outcome. Long-term follow-up was available in 17% (n=11) patients, with 75% (48/64) deceased. At a mean of 7 years (range, 4–17) mean DASH was 23.6 (range, 0.8–45.8), mean Oxford Elbow Score was 42 (range, 32–48). Overall patient satisfaction was 100% (n=11). One patient subsequently underwent open reduction internal fixation for malunion. We have reported satisfactory short-term and longer-term outcomes following the nonsurgical management of isolated distal humerus fractures in older lower demand patients.
