Surgical Outcomes of Coronal Shear Fracture of the Distal Humerus in Elderly Adults

Background: This study evaluated clinical outcomes of elderly adults with corona! shear fractures (CSFs) of the distal humerus treated by open reduction and internal fixation (ORIF). Methods: Between April 2002 and March 2019, data from eight elderly patients (76.3 +/- 5.1 years) with CSFs of the distal humerus were analyzed retrospectively. Postoperative complications, range of motion of the elbow joint, and functional elbow scoring (Mayo Elbow Performance Score; MEPS) were assessed. Results: The mean follow-up duration was 23.6 +/- 13.9 months. CSFs were treated by a buried implantable headless screw or Kirshner wires or bioresorbable screw with/without lateral locking plates. There were no superficial or deep infections or elbow joint instability. Seven patients obtained fracture healing, but one patient exhibited nonunion. Osteochondritis dissecans was present in one patient. Three patients had a step-off deformity (>2 mm) of the articular surface. Two patients exhibited collapse of the fractured articular surface. A patient with severe comminution of both the capitellum and trochlea exhibited collapse of the entire articular surface, with osteonecrosis of the capitellum and trochlea. Mean range of motion of the elbow was 116.3 +/- 12.7 degrees of flexion and -28.8 +/- 14.1 degrees of extension. The mean MEPS was 78.8 +/- 10.2 points, representing patients scored as excellent (n=1), good (n=3), and fair (n=4). Conclusions: ORIF yielded satisfactory outcomes for elderly adults with noncomminuted CSFs of the distal humerus. However, treatment of comminuted articular fracture fragment and complex posterior fracture remains challenging.