Huang Teng-Le, Chiu Fang-Yao, Chuang Tien-Yow, Chen Tain-Hsiung
Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
J Trauma. 2005 Jan;58(1):62-9. doi: 10.1097/01.ta.0000154058.20429.9c.
We would like to define the results of treatment of open reduction and internal fixation in elderly patients with severe fractures of the distal humerus.
Between 1988 and 1998, 19 consecutive aged patients (older than 65 years old) with displaced comminuted articular fractures of the distal humerus were treated by open reduction and internal fixation with AO reconstruction plate. The age at the time of injury was 71.9 (65-79) years old. According to the AO classification, 15 patients had type C2 and four had type C3 injury. No patient had inflammatory arthritis of the elbow. The period of follow up is 97.2 (60-174) months.
All fractures united with union time of 14.6 (11-20) weeks. No implant failure was found. In final follow up, the average flexion contracture was 16.8 degrees with a range of 0-40 degrees , the average active flexion was 128.4 degrees with a range of 115-140 degrees , the average pronation was 80 degrees with a range of 60-90 degrees , and the average supination was 78 degrees with a range of 60-90 degrees . According to the elbow motion classification of Cassebaum, eight (42.1%) patients were graded as very good elbow motion, eight (42.1%) as good, three (15.8%) as fair, and none as poor. The functional results showed that 15 (79%) patients had excellent results, four (21%) had good results, and none had fair or poor results, according to Mayo elbow performance score. The radiographic evaluation in final follow up showed that four patients (21%) had no osteoarthritic (OA) change, 11 (58%) had grade 1 OA, four (21%) had grade 2 OA, and none had grade 3 OA (the scale of Knirk and Jupiter). Fifteen (79%) patients reported no pain and four (21%) had mild pain. All patients were satisfied with their results. However, There were two early post-operative complications, including one (5.3%) superficial wound infection and one (5.3%) iatrogenic ulnar nerve injury.
Open reduction and internal fixation with appropriate surgical technique is effective in the treatment of displaced fractures of the distal humerus in elderly patients.
我们想要明确老年肱骨远端严重骨折切开复位内固定治疗的结果。
1988年至1998年期间，19例连续的老年患者（年龄大于65岁），其肱骨远端移位粉碎性关节骨折采用AO重建钢板切开复位内固定治疗。受伤时年龄为71.9（65 - 79）岁。根据AO分类，15例为C2型，4例为C3型损伤。无患者患有肘部炎性关节炎。随访时间为97.2（60 - 174）个月。
所有骨折均愈合，愈合时间为14.6（11 - 20）周。未发现内固定失败。末次随访时，平均屈曲挛缩为16.8度，范围为0 - 40度；平均主动屈曲为128.4度，范围为115 - 140度；平均旋前为80度，范围为60 - 90度；平均旋后为78度，范围为60 - 90度。根据Cassebaum肘关节活动分类，8例（42.1%）患者肘关节活动评为优，8例（42.1%）为良，3例（15.8%）为中，无评为差。根据Mayo肘关节功能评分，功能结果显示15例（79%）患者结果为优，4例（2（1%）为良，无评为中或差。末次随访的影像学评估显示，4例（21%）患者无骨关节炎（OA）改变，11例（58%）为1级OA，4例（21%）为2级OA，无3级OA（Knirk和Jupiter分级）。15例（79%）患者报告无疼痛，4例（21%）有轻度疼痛。所有患者对其结果满意。然而，术后早期有2例并发症，包括1例（5.3%）浅表伤口感染和1例（5.3%）医源性尺神经损伤。
采用适当的手术技术进行切开复位内固定治疗老年肱骨远端移位骨折是有效的。
