Fractures of the distal humerus (DH) are common in all age groups and account for 0.5-5.0% of musculoskeletal fractures and about 30.0% of fractures in the elbow joint (EJ). At the same time, intraarticular fractures of the DH are reported in 10.0-24.0% of all intraarticular injuries in adults.
Treatment of DH fractures is aimed at anatomical restoration of the damaged segment in order to reproduce the adequate function of the EJ necessary for daily life activity of the patient, which is characterized by the value of the Morrey range of motion of 1000.
Developed numerous ways of operative and conservative treatment of DH fractures indicate the search for optimal treatment tactics. Conservative methods of treatment for DH fractures often lead to the formation of contractures of the EJ and cause treatment complications if used unreasonably and incorrectly. Surgical treatment is used for comminuted fractures, displaced fractures, and intraarticular fracture localization. Complications develop in 18.0-85.0% of cases and 29.9% of victims have signs of disability, giving these fractures a reputation for injuries with a poor prognosis for functional recovery.
The aim of the study - is to evaluate the results of treatment of patients with distal humerus fractures.
The author analyzed the results of operative and conservative treatment 194 patients aged 19-89 years (mean age 50.2±1.3 years) with the DH fractures. Male was – 75 (38.7%), female – 119 (61.3%). According to AO/ASIF classification the fracture was type ? – 15 (7.7%); type ? – 40 (20.7%); type ? – 139 (71.6%). According to
Method
of treatment all patients were divided into 2 groups (1 - operative and 2 - conservative treatment) and each group into 2 subgroups (basic and control). The 1 group (operative treatment) was 140 (72.2%) patients, 99 (70.7%) – basic subgroup and 41 (29.3%) control. The 2 group (conservative treatment) was 54 (27.8%) patients, 29 (53.7%) – basic subgroup and 25 (46.3%) control. The basic methods of treatment in 1 group was: osteosynthesis by pins in 10 (7.1%) patients, external fixation device - 10 (7.1%), osteosynthesis by screw - 17 (12.2%), combine osteosynthesis - 49 (35.0%) and osteosynthesis by plates - 54 (38.6%). The methods of treatment in 2 groups were: cast immobilization in 43 (79.6%) patients and skeletal traction - 11 (20.4%).
Method
of combined osteosynthesis for the DH fractures is offered. Indications to the methods of treatment depending on the type of fracture are defined and dependence of the development of complications of treatment on duration of EJ immobilization is proved. Periods and approaches of restoration treatment are developed, the dependence of results of restoration treatment on the type of fractures and method of treatment is set.
The average follow-up was 39.0±0.8 months (from 7 months to 6 years) after trauma. The average score according to the Mayo clinic scale was 81.7±1.2 points (from 45 to 100). Analyzing the results of treatment 194 patients with the DH fractures showed that application of the differentiated approaches of treatment positive results are got for 91.4% of patients, in comparison with 71.2% of the control subgroup (p<0.001), and the number of complications.