Predictors of reoperation after internal fixation of intra-articular distal humerus fractures

Jeremy S. Somerson, Mark E. Morrey, Joaquin Sanchez-Sotelo, Bernard F. Morrey

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Despite good reported outcomes with open reduction and internal fixation of intra-articular distal humerus fractures, complication rates remain high. The objective of this work is to identify factors associated with reoperation. Methods: Sixty-three patients treated with open reduction and internal fixation for intra-articular (Arbeitsgemeinschaft für Osteosynthesefragen type C) distal humerus fractures between 2004 and 2010 were identified using an institutional trauma registry, 62 of which were followed for a minimum of six months. Age, gender, fracture subclassification, open fracture presence, Injury Severity Score, time to definitive surgery, length of postoperative immobilization, and type of approach were recorded. Multivariate analysis was utilized to identify factors independently associated with reoperation. Results: Complications requiring reoperation developed in 25 (40.3%) elbows. The most common reasons were wound dehiscence or infection in nine elbows (14.5%) and symptomatic hardware in six (9.6%). During multivariate analysis, only olecranon osteotomy remained an independent predictor for reoperation (P = 0.043). Discussion: Despite improved internal fixation techniques, a high proportion of elbows require reoperation after open reduction and internal fixation for distal humerus fractures. Higher complication rates in fractures fixed through an olecranon osteotomy may reflect additional reoperations due to nonunion of the osteotomy or need to remove hardware from the ulna. Level of evidence: Prognostic Level III.

Original languageEnglish (US)
JournalShoulder and Elbow
DOIs
StateAccepted/In press - Jan 1 2020
Externally publishedYes

Keywords

  • complications
  • distal humerus fractures
  • hardware removal
  • olecranon osteotomy
  • open reduction internal fixation
  • reoperation

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation
  • Surgery
  • Rehabilitation

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