Journal of Clinical & Experimental Orthopaedics

Elderly patients, multiple comorbiditiesâ?¦should we treat intraarticular distal humerus fractures with surgery?

Introduction

We present a case of two patients with distal humerus fracture (DHF), treated conservatively with an above elbow backslab (AEB). After 1 month of immobilization, followed by physiotherapy, both achieved good bone healing with negligible functional loss.

Case presentation

Two 79 year old patients, one male with rheumatoid arthritis, after STEMI, LCX stenting and bilateral total hip replacement followed by removal of the left prosthesis due to inflammation, and one female with arterial hypertension, diabetes type 2, after aortic valve replacement with warfarin treatment, suffered a metaphyseal comminutive fracture of the right distal humerus and left humerus lateral epicondylus fracture, respectively, both without distal neurocirculatory deficits.

In both patients, the broken limb was realigned and an AEB applied for 1 month, followed by physiotherapy. Upon follow up, both were able to utilize the arm in all daily activities, with completely unhindered pronation/supination. In the male, the final achieved range of elbow movement was +10/120°, with good secondary bone healing in a satisfactory position on x-ray. In the female, no elbow movement obstruction persisted, x-ray showing a healed radial epicondylus in a slight dislocation.

Discussion

Examination of literature clearly shows a tendency towards a surgical approach to DHF treatment due to poorer joint movement results after conservative “bag of bones” treatment. On the other hand, there are numerous reports of perioperative complications in DHF patients with significant comorbidities. In the presented two cases, based on x-ray imaging analysis and clinical presentation, taking the patient’s comorbidities into consideration, a surgical approach was omitted in favor of immobilization with an AEB.

Conclusions

In spite of conservative treatment of DHF being a generally unfavored approach, it is useful for select low demand patients with significant comorbidities and can achieve a favorable end result.

Author(s):

Nikolic A, Gersak B.M. and Hermann D.

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