Functional Outcome Following Surgical Treatment of Intra-Articular Distal Humeral Fractures Through a Posterior Approach

BackgroundWhile 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...

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Bibliographic Details
Published in:Journal of bone and joint surgery. American volume 2000-12, Vol.82 (12), p.1701-1701
Main Authors: McKee, Michael D, Wilson, Tracy L, Winston, Lucy, Schemitsch, Emil H, Richards, Robin R
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
Female
Fracture Fixation, Internal
Humans
Humeral Fractures - diagnostic imaging
Humeral Fractures - physiopathology
Humeral Fractures - surgery
Male
Medical sciences
Middle Aged
Orthopedic surgery
Prognosis
Radiography
Range of Motion, Articular - physiology
Recovery of Function - physiology
Retrospective Studies
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surveys and Questionnaires
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Summary:BackgroundWhile 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).MethodsWe 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.ResultsThe 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.ConclusionsThe 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
ISSN:0021-9355
1535-1386
DOI:10.2106/00004623-200012000-00003