The Journal of Bone and Joint Surgery 82:1701 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.
Functional Outcome Following Surgical Treatment of Intra-Articular Distal Humeral Fractures Through a Posterior Approach*
Michael D. McKee, M.D., F.R.C.S.(C) ,
Tracy L. Wilson, M.D., F.R.C.S.(C),
Lucy Winston, B.Sc.(OT), C.H.T.,
Emil H. Schemitsch, M.D., F.R.C.S.(C) and
Robin R. Richards, M.D., F.R.C.S.(C)
Investigation performed at St. Michael's Hospital and the
Toronto East General Hospital, University of Toronto, Toronto, Ontario,
Canada
*No benefits in any form have been received or will be received
from a commercial party related directly or indirectly to the subject
of this article. No funds were received in support of this study.
Upper Extremity Reconstructive Service (M. D. McK., T. L. W.,
L. W., and R. R. R.) and Division of Orthopaedics (E. H. S.), St.
Michael's Hospital and the University of Toronto, Suite 800, 55 Queen
Street East, Toronto, Ontario M5C 1R6, Canada. E-mail address for
M. D. McKee: mckee{at}the-wire.com
Background: While surgical repair is considered
the standard of care of displaced intra-articular distal humeral fractures,
most investigators have assessed its results with use of surgeon-based
and/or radiograph-based outcome measures. The purpose of our study
was to determine the functional outcome of fixation of displaced
intra-articular distal humeral fractures with use of a standardized
evaluation methodology consisting of objective testing of muscle
strength and use of patient-based questionnaires (both limb-specific
and general health-status questionnaires).
Methods: We identified twenty-five patients
(fourteen male and eleven female), with a mean age of forty-seven
years, who had an isolated, closed, displaced, intercondylar, intra-articular
fracture of the distal part of the humerus repaired operatively
through a posterior approach and fixed with plates on both the medial
and the lateral column. All patients returned for follow-up that
included recording of a complete history, physical examination,
radiographic examination, completion of both a limb-specific questionnaire
(Disabilities of the Arm, Shoulder and Hand [DASH]) and a general
health-status questionnaire (Short Form-36 [SF-36]), and objective
muscle-strength testing.
Results: The mean duration of follow-up was
thirty-seven months (range, eighteen to seventy-five months). The
mean flexion contracture was 25 degrees (range, 5 to 65 degrees),
and the mean arc of flexion-extension was 108 degrees (range, 55
to 140 degrees). Significant decreases in mean muscle strength compared
with that on the normal side were seen in both elbow flexion measured
at 90 degrees (74 percent of normal, p = 0.01) and elbow extension
measured at 45 degrees (76 percent of normal, p = 0.01), 90 degrees
(74 percent of normal, p = 0.01), and 120 degrees (75 percent of
normal, p = 0.01). The mean DASH score was 20 points, indicating
mild residual impairment. The SF-36 scores revealed minor but significant
decreases in the role-physical and physical function scores (p =
0.01 and 0.03, respectively) but no alteration of the mental component
or mean scores. Six patients (24 percent) had a reoperation; three of
them had removal of prominent hardware used to fix the site of an
olecranon osteotomy.
Conclusions: The surgical repair of an intra-articular
distal humeral fracture is an effective procedure that reliably
maintains general health status as measured by patient-based questionnaires.
Our study quantified a decrease in the range of motion and muscle strength
of these patients, which may help to explain the mild residual physical
impairment detected by the limb-specific outcome measures and physical
function components of the general health-status measures.
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