Fractures of the distal humerus in the elderly: is internal fixation the treatment of choice?

The incidence of osteoporotic fractures of the distal humerus is increasing, and the treatment of these injuries merits closer review. We assessed the results of 28 elderly patients (29 fractures) with a mean age of 85 years (range, 75-100 years). Open reduction and internal fixation was done on 21 elbows, and eight elbows were treated nonoperatively. Orthopaedic Trauma Association grading showed that the group treated with internal fixation had favorable results (three excellent, nine good, seven fair, and two poor) compared with the nonoperatively treated group (zero excellent, two good, three fair, and three poor). Mean loss of extension and mean flexion were better in the surgically treated patients (23.5 degrees and 99 degrees ) than in the nonoperatively treated patients (33.5 degrees and 71 degrees ). Substantial pain relief (mild or no pain) was achieved in a higher proportion (52%) in the surgically treated group than in the nonoperatively treated group (25%). Anatomic restoration of distal humeral tilt and articular congruity also were better in the surgically treated patients. Rates of complications were observed to be comparable to those described in the literature for younger patients. These findings reflect the relevance of surgical fixation of such fractures in this age group highlighting the need for additional clinical studies.