Distal humerus fracture in the elderly: does conservative treatment still have a role?

INTRODUCTION: Conservative treatment is exceptional in fracture of the distal extremity of the humerus in patients over 65 years of age. In a selected population, however, it may be an attractive option. MATERIALS AND METHODS: One prospective and one retrospective study included a total of 56 patients, with a mean age of 84.7 years (range, 68-100 yrs). All were managed by 6 to 8 weeks' brachial-antebrachial-palmar immobilization, without fracture reduction. Fractures were AO type A in 18 cases, type B in 8 cases and type C in 30 cases. RESULTS: At a mean 20.2 months' follow-up in the retrospective and 8.6 months in the prospective series, mean MEPS score was 83 and 86 points with 75% and 83% satisfactory results respectively and mean Quick-DASH 31.3 and 34.4 points respectively. There were 3 non-unions. There was extra-articular malunion in 70% and intra-articular malunion in 65% of cases in the retrospective series, versus 16% intra-articular malunion in the prospective series. The rate of osteoarthritis increased over time, with more than 50% grade 2 or 3 in the retrospective series at end of follow-up. There were 3 complications: 2 hematomas and 1 skin lesion (localized pressure ulcer). There were 3 fracture displacements, not requiring change in management. DISCUSSION: Conservative treatment for fracture of the distal extremity of the humerus in patients over 65 years of age is exceptional, but conserves patient's independence and provides satisfactory clinical results, with no significant joint stiffness or elbow instability. Non-anatomic results on X-ray, however, have to be accepted.

Fascial flap protecting the fibular nerve: a rare childhood case.

Compression of the peripheral nerves (PNs) induces intraneural lesions, which, once surgical decompression has been achieved, requires that the peripheral scar tissue be as non-adherent as possible. This allows optimal nerve tissue regeneration and the flexibility necessary for longitudinal movements of the PNs. In cases showing a risk for adherence, tissue interposition (with fat, muscle, fascia, etc.) can be proposed. The authors describe the use of a fascial flap of the fibular muscles used to protect the fibular nerve (FN) and the fibula head. This flap procedure was performed in a case of PN compression due to exostosis of the fibular nerve in a child.

Vein conduit associated with microsurgical suture for complete collateral digital nerve severance.

The aim of this study is to present the long term results of a series of 53 vein conduit grafts as first line therapy to repair complete severance of one or more collateral digital nerves. The surgical technique included an epi-perineural suture of the nerve under minimal tension, associated with a vein graft harvested from the back of the hand to cover the nerve. None of the patients presented with a neuroma, spontaneous pain or had stopped using the injured finger. Sensibility results were good or very good in 67% of cases. The scar at the donor site was very light or invisible. A total of 96% of patients were satisfied or very satisfied. This simple technique, by protecting the injured nerve, results in a rate of sensory nerve recovery that is comparable or better than that of other series in the literature, without neuroma and with minimal scarring at the donor site.