Results of internal fixation of distal humeral articular fractures in old age, study of 10 cases

In elderly patients the tolerance of elbow joint to immobilization is very poor and stiffness develops easily, so conservative treatment is not suitable method for intraarticular fractures of the distal humerus. Although open reduction and internal fixation is the treatment of choice for these fractures in adults, in elderly patients disagreement remains on how to treat these fractures. Also the reports on the functional results after internal fixation of these fractures in elderly patients are rare. The purpose of this study is to evaluate the results of open reduction and stable internal fixation for treatment of intra-articular fractures of distal humerus in elderly patients above 60 years old. 10 patients with 10 intr a-articular fractures of distal humerus. The average age was 63 years [ranged 60-73 years]. There were sex females [60%] and four male [40%]. The right side was affected in seven patients [70%] and left side in three patients [30%]. The fractures were classified according to the AO/ASIF classification. There was one fracture [10%] type B1, four fractures [40%] type C1, three fractures [30%] type C2 and two fractures [20%] type C3. All the patients were treated by open reduction and internal fixation through a posterior approach. The average follow up period was 18 months [ranged 12-32 months] During it the patients were examined both clinically and radiographically for union of the fractures, Post-traumatic arthritis, range of motion, the elbow and forearm, muscle strength, degree of pain, return to previous activities. The final results tuere evaluated according to the Mayo Elbow scoring points system. Average time to union were 3.5 months [ranged 2-4.5months]. Four patients [40%] had Post-traumatic arthritis of the elbow [three patients with mild degree and one patient with severe degree]. The motion at the elbow was mainly affected, the median arc of flexion/ extension was 1000 [ranged 600-1300]. The forearm motion was not affected and it was near normal in all of the cases. The final clinical results were excellent in three patients [30%], good in five patients [50%], fair in one patient [10%], and poor in one patient [10%]. Open reduction and internal fixation of distal humeral intra-articular fractures in elderly patients can achieve excellent and good results in majority of the patients. Advancing age is not a contraindication for open reduction and internal fixation of these fractures

Modified extension block pinning for large mallet fractures

Treatment of a mallet finger due to an intra-articular fracture of the distal phalanx involving one-third or more of the articular surface is controversial Twenty one mallet fractures involving more than 33% of the articular surface and fractures associated with subluxation of the distal phalanx that could not be corrected by closed reduction are treated with an extension block pin and transarticular fixation of the distal interphalangeal joint. The average patient age was 26.8 years and the average fracture size was 40.5% of the joint surface. The average delay after injury was 5.6 days [range, 0-14 days] Average time to fracture union was 32 days. The average active flexion of the distal interphalangeal joint was 81.2° and the average extensor lag was 1.4°. There were no major complications. Using the established outcome criteria for mallet injuries, 95.2% had excellent or good results. This surgical technique resulted in rapid fracture union with only minor complications and has excellent functional outcome