Introduction: Distal humerus fracture in adults particularly complete articular (AO/OTA Type C) remain some of the most difficult injuries to manage. Complex anatomy of distal humerus combined with multifragmented fracture, sparse soft tissue cover with adjacent neurovascular structures poses great difficulty for treatment. Goal of treatment is to obtain a painless, stable and mobile elbow joint through a systematic approach. Aim: to study the functional outcome of surgical management of complete articular distal humerus fracture in adults. Method: a prospective study comprising of 20 patients treated surgically with open reduction and internal fixation using Orthogonal plating (dorsolateral and medial 3.5mm LCP) through trans olecranon approach. Result: Mean age of patients was 36.6 years (range 19 to 58 years) with male dominance, most fractures were of type 13C1 (AO/OTA). RTA accounts for most common mode of injury, majority of them being left sided. Mean operative time was 130 minutes. Complications included one case of superficial infection, 3 cases of ulnar neuropathy and non-union in 2 cases. Mean range of motion of elbow was 89 degree. Functional outcome assessed using Mayo Elbow Performance Score (MEPS) shown Excellent result in 12 cases, good to fair results in 6 and poor result in 2 cases. Conclusion: Anatomical restoration of joint surface and rigid internal fixation with bicolumnar orthogonal plating allowing early range of motion is the key for obtaining good functional results in complete articular distal humerus fractures. However, outcomes do deteriorate with increasing fracture complexity.
Distal humerus fracture in the elderly: Does conservative treatment still have a role?
