Treatment of Distal Humeral Fractures in Elderly Patients

Where Are We in 2020? A Review Article

Anthony V. Christiano, MD; James D. Dieterich, MD; Gregory M. Frechette, MD; Andrew J. Lovy, MD; Jaehon M. Kim, MD; Michael R. Hausman, MD

Disclosures

Curr Orthop Pract. 2020;31(6):579-581. 

In This Article

Abstract and Introduction

Abstract

Distal humeral fractures are increasing in the elderly population and pose a difficult clinical problem as orthopaedic surgeons attempt to maximize return of function and avoid complications. Many treatments have been suggested for distal humeral fractures in the elderly, with operative intervention becoming a mainstay of treatment for active patients. Open reduction internal fixation (ORIF) and total elbow arthroplasty (TEA) have been utilized with both success and complications. The available literature appears to be equivocal on the ideal treatment of geriatric distal humeral fractures, with well-done TEA and ORIF demonstrating similar outcomes. Failed fixation of geriatric distal humeral fractures can be reliably converted to TEA without worsened outcomes but requires a second surgery. TEA demonstrates equivalent outcomes, but with activity limitations for the lifespan of the patient that may inhibit the use of walking aids. There also may be decreased hardware survivorship when TEA is employed for acute fracture. Surgeons and patients must weigh the risks and benefits of treatment with TEA associated with functional restrictions and possible decreased hardware survivorship. TEA does not have the reliable fallback option, but ORIF requiring a second surgery can be converted to TEA.

Introduction

Distal humeral fractures in elderly patients are difficult for orthopaedic surgeons to treat, attempting to maximize return of function while avoiding complications. In a review of 63 elderly patients with distal humeral fractures, Korner et al.,[1] stated that these fractures are commonly plagued with a combination of poor bone quality, comminution, and inability to tolerate immobilization that makes management more challenging. Though relatively rare, distal humeral fractures occur at a rate of 5.7 per 100,000 per year. They present in a bimodal distribution occurring in young men with a high-energy mechanism of injury, such as traffic accidents, and elderly women with a low energy mechanism of injury, such as simple falls.[2] In studying this elderly population, Bergdahl et al.,[3] in their review of 2011 humeral fractures in the Swedish fracture register, demonstrated that of distal humeral fractures caused by simple falls, 79.6% occurred in women, 90.3% occurred in patients aged older than 50 yr (mean 71.3 yr), and 29% were AO Foundation/Orthopaedic Trauma Association (AO/OTA) C-type fractures. Additionally, the rate of distal humeral fractures is increasing in this elderly population, and the best treatment is yet to be established.[4]

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