Background: The short-term results of open reduction and internal
fixation of intra-articular distal humeral fractures are good to excellent in
approximately 75% of patients, but the long-term results have been less well
studied. This investigation addressed the long-term clinical and radiographic
results of surgical treatment of intra-articular distal humeral fractures (AO
Type C) as assessed with use of standardized outcome measures.
Methods: Thirty patients were evaluated at an average of nineteen
years (range, twelve to thirty years) after open reduction and internal
fixation of a fracture of the distal part of the humerus to assess the range
of elbow motion and the functional outcome. Twenty patients had an olecranon
osteotomy, and all had fixation with plates and/or screws and/or Kirschner
wires. No ulnar nerve was transposed.
Results: Excluding one elbow salvaged with an arthrodesis and
counted as a poor result, the average final flexion arc was 106° and the
average pronation-supination arc was 165°. The average American Shoulder
and Elbow Surgeons (ASES) score was 96 points, with an average satisfaction
score of 8.8 points on a 0 to 10-point visual analog scale. The average
Disabilities of the Arm, Shoulder and Hand (DASH) score was 7 points, and the
average Mayo Elbow Performance Index (MEPI) score was 91 points. Including the
patient with the arthrodesis, the final categorical ratings were nineteen
excellent results, seven good results, one fair result, and three poor
results. The presence of arthrosis did not appear to correlate with pain or
predict disability or function. Subsequent procedures were performed in twelve
patients (40%).
Conclusions: The long-term results of open reduction and internal
fixation of AO-Type-C fractures of the distal part of the humerus are similar
to those reported in the short term, suggesting that the results are durable.
Functional ratings and perceived disability were predicated more on pain than
on functional impairment and did not correlate with radiographic signs of
arthrosis.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.