78 - Freie Mitteilung
16. Mai 2019, 17:30 - 19:00, Sopra 3, 4. OG
Treatment of distal humeral fractures in geriatric patients aged 80 years and older
B. Oberreiter, U. Can, M. Leimbacher, A. Platz, Presenter: B. Oberreiter (Zürich)
Fractures of the distal humerus are rare, only 2% of all fractures occur in this region. We see two patient groups, young patients with high energy trauma and a high percentage of open fractures and a big group of elderly patients after low energy trauma. These osteoporotic fractures are quite challenging to treat. We often find comminuted fractures, bad bone quality and we have to deal with medical comorbidities. The surgical treatment is the gold standard in the treatment of distal humeral fractures but sometimes, we prefer a conservative treatment because of the age or associated comorbidities. The goal of this study was to analyse the results of conservative and surgical treatment of distal humeral fractures in a geriatric patient collective.
We analysed all patients treated with a distal humeral fracture at our clinic in the last 10 years aged 80 or older. We considered the type of treatment - either bracing for conservative treatment or surgery with LCP Distal Humerus Plates (DHP) ®, radiological healing of the fracture as well as the complication rate and the clinical outcome.
Between 2009 and 2018 we treated 26 patients in this age group with a distal humeral fracture. The average age was 87.1 years, we had 20 females and 6 males. 15 of them were treated conservatively, 9 underwent primary surgery und in 2 cases the decision of a conservative treatment was changed after a few weeks and a surgery was performed. 21 patients were seen regularly in our outpatients department, 2 patients were lost to follow up and 3 died short time after the injury (all of them were treated conservatively). Out of 11 fractures treated surgically, 10 fractures healed after osteosynthesis with DHP®. In one case a fracture-dislocation occurred immediately after surgery so that a prosthesis had to be performed. Another patient developed a wound infection. Out of the 15 fractures treated conservatively only one healed. All other patients developed a pseudarthrosis.
Regardless of the age of the patient, the surgical treatment is the gold standard in the treatment of distal humeral fractures. Conservative treatment is associated with a high rate of pseudarthrosis and should be reserved only to low demanding patients with severe comorbidities.