Fixation of distal humeral fracture in elderly patient by locking compression plate.

Abstract

OBJECTIVE: To review the outcomes of geriatric distal humeral fracture fixed with locking compression plate (LCP). METHODS: From January 2005 to December 2007, 24 patients (20 females and 4 males) with distal humeral fracture underwent open reduction and internal fixation with LCP. Their average age was 75.5 years old, ranged from 60 to 93 years old. Fracture was caused by injury from fall in 22 cases, by traffic accident in 1 case, and by direct hit in 1 case. There were 12 cases of type A2, 2 cases of type A3, 2 cases of type B1, 2 cases of type C1, 2 cases of type C2, 4 cases of type C3 fractures according to AO/ASIF classification. X-ray films in AP and lateral view were taken preoperatively. CT scan with three dimensional reconstructions was done in more comminuted fracture only. Open reduction with triceps sparing technique was used in all except type B fracture, and olecranon osteotomy was considered only in more comminuted C3 fracture. The average interval between injury and operation was 3 days (range, 1-6 days). Outcome measures included pain assessment, range of motion, and Mayo elbow performance score and findings at 1 year follow-up. RESULTS: The average length of follow-up was 25 months (range, 12-48 months). All 24 fractures were healed within 6 months with an average of about 4 months. At 1 year follow-up, 83% (n = 20) of patients felt no pain and 17% (n = 4) of patients had mild pain; 83% of patient can gain a flexion range of more than 100 degrees; according to Mayo elbow performance score, the mean scores of type A, B and C fracture groups were 97, 85, and 89, respectively, and the post-operative performance of type A fracture was significantly better than that of type B and C (P = 0.034). Four patients had postoperative complications. CONCLUSION: Open reduction and internal fixation of geriatric distal humeral fracture can achieve relatively good functional result and bony union despite of age.

目的探討鎖定加壓鋼板(locking compression plate,LCP)內固定治療老年肱骨遠端骨折的療效。方法2005年1月-2007年12月,采用切開復位LCP內固定治療肱骨遠端骨折24例。男4例,女20例;年齡60～93歲,平均75.5歲。致傷原因:摔傷22例,交通傷1例,擊打傷1例。其中左側及右側各12例。按AO/ASIF分型:A2型12例,A3型2例,B1型2例,C1型2例,C2型2例,C3型4例。所有患者術前均攝正側位X線片;CT三維重建診斷C型粉碎性骨折。受傷至手術時間1～6d,平均3d。術中經肱三頭肌兩側入路(B型骨折患者除外),切開復位后LCP內固定肱骨遠端骨折;C3型骨折患者行尺骨鷹嘴截骨。觀察術后并發癥發生情況,并于術后12個月行疼痛及肘關節活動度評定,并采用Mayo肘關節功能評分評價肘關節功能。結果術后24例患者均獲隨訪,隨訪時間12～48個月,平均25個月。骨折均于6個月內愈合,平均4個月。術后12個月,20例(83%)無疼痛,4例(17%)中度疼痛;20例(83%)肘關節屈曲>100°;A、B、C型骨折Mayo肘關節功能評分平均分別為97、85、89分;A型骨折與B、C型骨折評分差異有統計學意義(P=0.034)。4例(17%)術后出現并發癥。結論切開復位LCP內固定治療老年肱骨遠端骨折,術后肘關節功能恢復較好,骨折可達骨性愈合。