Varecka Thomas F, Myeroff Chad
From the Department of Orthopaedic Surgery, Hennepin County Medical Center, Minneapolis, MN.
J Am Acad Orthop Surg. 2017 Oct;25(10):673-683. doi: 10.5435/JAAOS-D-15-00683.
Distal humerus fractures present complex challenges in the elderly patient. These fractures often occur in patients who are living independently but have poor bone quality and low physiologic reserve, thus complicating management decisions and treatment. The goal is a painless, functional, stable elbow that allows completion of the activities of daily living. Nonsurgical management is reserved for those who cannot tolerate surgery. Open reduction and internal fixation is the preferred choice in fractures amenable to rigid fixation and early motion. Although total elbow arthroplasty provides improved early function and similar overall outcomes in appropriately selected patients, it has the potential to cause devastating complications. With modern technology and treatment principles, as well as early definitive treatment by an experienced specialist, predictable return to function can be expected.
肱骨远端骨折给老年患者带来了复杂的挑战。这些骨折常发生在独立生活但骨质较差且生理储备较低的患者中，从而使治疗决策和治疗变得复杂。目标是获得一个无痛、功能良好且稳定的肘关节，以完成日常生活活动。非手术治疗适用于那些无法耐受手术的患者。切开复位内固定是适合进行坚强固定和早期活动的骨折的首选治疗方法。尽管全肘关节置换术在适当选择的患者中能提供更好的早期功能和相似的总体疗效，但它有可能导致严重的并发症。凭借现代技术和治疗原则，以及由经验丰富的专家进行早期明确治疗，可以预期患者能获得可预测的功能恢复。
