The Journal of Bone and Joint Surgery (American). 2007;89:1524-1532.
doi:10.2106/JBJS.F.00369
© 2007 The Journal of Bone and Joint Surgery, Inc.
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Surgical Treatment of Intra-Articular Fractures of the Distal Part of the Humerus

Functional Outcome After Twelve to Thirty Years

Job N. Doornberg, PhD1, Pleun J. van Duijn, BS1, Durk Linzel, BS1, David C. Ring, MD, PhD2, David Zurakowski, PhD3, Rene K. Marti, MD, PhD1 and Peter Kloen, MD, PhD1

1 Orthotrauma Research Center Amsterdam (J.N.D., P.J.v.D., and D.L.) and Department of Orthopaedic Surgery (R.K.M. and P.K.), Academic Medical Center, G4-Noord, Kamer 249, Meibergdreef 9, 1100 DD Amsterdam, The Netherlands. E-mail address for J.N. Doornberg: jdoornberg{at}partners.org
2 Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114
3 Department of Orthopaedic Surgery, Children's Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115

Investigation performed at Academic Medical Center, Amsterdam, The Netherlands

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

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.


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