Distal humerus fractures in subjects over 65 years old: about 62 cases in Moroccan population.

Abstract

Distal humerus fractures, defined as interruptions of bone continuity below the insertion of the anterior brachial muscle, are relatively rare, representing 1 to 2% of all fractures. These fractures display a bimodal distribution, predominantly affecting young men (12-19 years old) due to violent trauma and elderly women (>80 years old) due to low-energy trauma associated with osteoporosis. This study aims to present the clinical, radiological, and therapeutic outcomes of distal humerus fractures in subjects over 65 years. A retrospective analysis of 62 cases treated surgically with plates at CHU Hassan II in Fes, Morocco, from January 2010 to December 2023 was conducted. Patients included were over 65 years old with non-pathological distal humerus fractures. Data were collected on epidemiology, fracture characteristics, surgical treatment, complications, and functional outcomes. The average age of patients was 73 years, with equal gender distribution. Most fractures resulted from simple falls (56%) and road traffic accidents (33%). Common comorbidities included hypertension, dyslipidemia, obesity, and confirmed osteoporosis. Surgical treatment with plates, predominantly using the posterior approach, showed a high consolidation rate of 89%. Complications included infection, ulnar nerve paresthesia, stiffness, malunion, and nonunion. Functional outcomes, assessed using the Mayo Clinic Elbow Performance Score, were excellent to good in 64.5% of patients, with significant pain relief and satisfactory mobility observed in most cases. In conclusion, managing distal humerus fractures in individuals over 65 is challenging due to anatomical complexity and comorbidities. Conservative surgical treatment with dual plating, particularly parallel plating with anatomical pre-molded plates, provides superior stability and favorable functional outcomes, emphasizing the importance of stable fixation and early rehabilitation.