[Distal intraarticular humerus fractures in elderly patients. Treatment with combined percutaneous screw fixation and an external fixator].

BACKGROUND: Intra-articular distal humerus fractures are relatively uncommon. Due to osteoporosis in elderly patients, stable fixation still remains a problem despite new implants providing angular stability.
MATERIAL AND METHODS: The treatment of choice is open reduction and plate fixation requiring an extended approach with olecranon osteotomy often combined with additional postoperative immobilisation in a long arm cast. We describe a technique using closed reduction and percutaneous osteosynthesis with cannulated screws combined with external fixation. Morbidity due to surgical exposure and potential risks are diminished while functional results are comparable to open reduction and internal fixation . In contrast to plasters or casts, the use of an external fixator allows stable and safety protection of the elbow joint, preserving wrist function as well as forearm rotation and increasing the patient's comfort during immobilisation.
RESULTS: We have used this technique on ten patients aged 76.2 years (range 67-88 years). According to the AO classification, there were three B-1/B-2 fractures, four C-1 and three C-2/C-3 fractures without severe comminution. The duration of external fixation was 6.3 weeks (range 4-8 weeks) before fracture union was achieved. This allows the initiation of physiotherapy and motion of the elbow. There was only one revision caused by the necessary replacement of an aseptic loosened Schanz screw. At follow-up 3 months postoperatively, the range of motion of the elbow was 95 degrees (65 degrees-105 degrees ), average extension 25 degrees (10 degrees-35 degrees ) and mean flexion was 115 degrees (100 degrees-120 degrees ) with all patients exhibiting full pro/supination.