Wound complications after distal humerus fracture fixation: Incidence, risk factors, and outcome

Background: This study set out to accurately determine the incidence of wound complications after distal humerus fracture fixation, to assess risk factors, and to determine their implications on outcome. Methods: Eighty-nine distal humerus fractures (mean patient age, 58years) were treated with internal fixation at an average of 4days after injury. Mean follow-up time was 15months (range, 6-72months). Twenty-nine (33%) fractures were open. Medical records and radiographs were reviewed to determine wound complications. Logistic regression analysis was carried out to determine associated risk factors. Results: Fourteen patients (15.7%) developed a major wound complication requiring on average 2.5(range, 1-6) additional surgical procedures. Six patients required plastic surgical soft tissue coverage. All 14 fractures complicated by wound problems united. The final mean range of motion in the major wound complication group was 100° (range, 65°-130°), compared with 100° (range, 10°-140°) in those with no or minor wound problems. Grade III open fractures and the use of a plate to stabilize theolecranon osteotomy were identified as significant risk factors for development of major wound complications. Conclusions: The incidence of major wound complications after fixation of distal humerus fractures is substantial. The presence of a grade III open fracture and the use of an olecranon osteotomy stabilized with a plate are significant risk factors for major wound complications. Fracture healing rates and functional elbow range of motion do not appear to be affected by major wound complications when they are handled with proper soft tissue coverage techniques.