Comparative functional outcome of AO/OTA type C distal humerus fractures: open injuries do worse than closed fractures.

BACKGROUND: Open distal humerus fractures present significant soft-tissue injury and bone devitalization that require prompt irrigation and debridement, temporization, and soft-tissue coverage.

METHODS: This case-control comparison of open and closed AO type C fractures of the distal humerus tests the null hypothesis that there is no difference in the outcomes and prognosis of open versus closed distal humerus fractures treated operatively. Outcomes were determined clinically and radiographically and reported by the Short Musculoskeletal Function Assessment, the Short Form-36,and the Mayo Elbow Performance Index.

RESULTS: Twenty-eight matched cohort patients treated by operative fixation were identified (14 open and 14 closed injuries), with average follow-up 98.9 weeks (range, 52–160 weeks). The average time to osseous healing after definitive treatment was 24.7 weeks for open fractures, when compared with 18.7 weeks for the closed group (p = 0.085). The average range of motion at final follow-up for open fractures was 82.5 degrees, versus 108.7 degrees for the closed group (p = 0.03). Short form-36 was significantly poorer(p = 0.002) in the open group (57.9) when compared with the closed group (79.0).

CONCLUSIONS: When compared with closed fractures, open distal humerus fractures have worse functional outcome scores and decreased range of motion. Patients with open fractures also demonstrated a trend toward having higher complication rates, prolonged times to union, and higher rates of persistent nerve deficits requiring further surgery.