Complications and functional outcomes after transolecranon distal humerus fracture

Cho, Elizabeth; Weber, Morgan B.; Opel, Dayton; Lee, Adrienne; Hoyen, Harry A.; Bafus, Blaine T.

doi:10.1016/j.jse.2020.07.012

Cited by 9 publications

(9 citation statements)

References 28 publications

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“…Although distal humerus fractures account for a small percentage of all fractures [ 1 ], high complication rates have been reported after surgical treatment due to fracture complexity and poor bone quality [ 2 , 3 ]. It is reported that up to 25% of non-unions occur after distal humerus fracture surgery [ 4 , 5 ]; in most cases, further operative treatment with revision ORIF or total elbow arthroplasty is necessary [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Non-Union after Open Reduction and Internal Fixation in Patients with Distal Humerus Fractures

Baek

Kim

2022

JCM

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Background: Only a few studies have reported on the risk factors for non-union after open reduction and internal fixation (ORIF) in distal humerus fractures. Methods: We retrospectively reviewed 155 patients who underwent ORIF for distal humerus fractures from January 2008 to June 2020. Various patient factors, including body mass index (BMI), diabetes mellitus (DM), and combined fracture, as well as surgical factors, including fixation methods (e.g., orthogonal plate/parallel plate/single plate/tension bend wiring [TBW]) and combined fracture operations, were evaluated as risk factors for non-unions. Results: Among the patient factors, BMI (25.0 ± 3.4 vs. 22.7 ± 3.4, p = 0.032), DM (5/13 [38.5%] vs. 20/142 [14.1%], p = 0.038) and combined fracture (5/13 [38.5%] vs. 16/142 [11.3%], p = 0.018) were significantly different between groups with non-union and union. Among the surgical factors, combined fracture operation (5 [38.5%] vs. 9 [6.3%], p = 0.002) and the fixation method (3 [23.1%]/1 [7.7%]/4 [30.8%]/5 [38.5%] vs. 84 [59.2%]/7 [4.9%]/40 [28.2%]/11 [7.7%], p = 0.005) showed a significant difference between groups with non-union and union. Multivariate regression analysis showed that combined fracture operation (OR 10.467; 95% CI 1.880–58.257; p = 0.007) and TBW (OR 9.176; 95% CI 1.474–57.135; p = 0.018) among the fixation methods posed as a significant risk factor for non-union. Conclusions: The risk of non-union increased in patients who underwent surgery for another fracture combined with distal humerus fracture and in patients who underwent ORIF with TBW.

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Section: Introductionmentioning

confidence: 99%

Risk Factors for Non-Union after Open Reduction and Internal Fixation in Patients with Distal Humerus Fractures

Baek

Kim

2022

JCM

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“…Four studies met inclusion criteria for data extraction and were level 4 evidence 16 . There was one case series 1 and one case report 17 of adult patients with transolecranon distal humerus fractures. There was one case series 18 and one case report 19 of pediatric patients with transolecranon distal humerus fractures.…”

Section: Resultsmentioning

confidence: 99%

“…In Cho's cohort 1 , the average extension-flexion arc was 74 degrees (range 0 -125 degrees) and average pronation-supination arc was 156 degrees (range 120 -180 degrees). Cho 1 reported Disabilities of the Arm, Shoulder, and Hand (DASH) scores for 10 patients. At an average of 3.8 years from the date of injury, the average DASH score was 40.2 (range 4.2 -76.5).…”

Section: Resultsmentioning

confidence: 99%

“…However, this is not a significant limitation. The two adult studies 1,17 were published in 2019 and 2021 and used modern implants for fixation of distal humerus and olecranon fractures in adults. The two pediatric studies were published in 2009 and 2016.…”

Section: Pediatric Cohortmentioning

confidence: 99%

“…Transolecranon distal humerus fractures are high-energy, traumatic injuries 1 . The mechanism of injury is an axial load of the distal humerus through the olecranon resulting in both distal humerus and olecranon fractures (Figure 1).…”

Section: Introductionmentioning

confidence: 99%

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Untitled

2021

J Orthopedics & Orthopedic Surg

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Background: Transolecranon distal humerus fractures are uncommon injuries. The purpose of this study is to review the outcomes and complications associated with transolecranon distal humerus fractures. Material and Methods:We performed a systematic search of PubMed for articles published between 1990 and 2021. Included studies reported outcomes and complications of transolecranon distal humerus fractures. Data was extracted from the included studies to describe patient demographics, injury characteristics, outcome measurements, and complications.Results: A total of 4 studies met inclusion criteria for data extraction and analysis. Two studies evaluated an adult cohort of a total of 18 patients. The average Disabilities of the Arm, Shoulder, and Hand (DASH) score was 40 (range 4.2 -76.5). Fifteen patients (83%) had a complication. Elbow stiffness (11/18, 61%) was the most common complication. Eleven patients (61%) underwent more than one procedure. Two studies evaluated a pediatric cohort of a total of 9 patients. Five patients (56%) underwent non-operative treatment with immobilization and four patients (44%) underwent open reduction and internal fixation. There were no complications reported. All the pediatric patients regained near full range of motion of the elbow at their final follow-up. Conclusion:Transolecranon distal humerus fractures are complex elbow injuries. In the adult population, they remain a challenge for orthopaedic surgeons. Complications, including elbow stiffness and infection, are high with frequent long-term functional limitations as represented by DASH scores. In contrast, pediatric patients have good outcomes and minimal complications that are similar to isolated olecranon and distal humerus fractures in children.

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