Do Implants Fail? Complications, Union, and Reoperation in Geriatric Distal Humerus Fractures
Ismail Aykut Kocyigit, Gokay Dursun, Erkan Akgun, Emrah Imat, Hatice Ezgi Rifaioglu, Ahmet Topcuoglu, Aytek Huseyin Celiksoz, Abdulsamet EmetBackground
Elderly distal humerus fractures can lead to substantial functional impairment. With a steadily aging population worldwide, understanding the outcomes of open reduction and internal fixation (ORIF) for distal humerus fractures in this group has become an important focus of orthopedic practice, and this study aims to identify factors affecting surgical outcomes in geriatric patients.
Methods
A total of 47 patients aged ≥65 years undergoing ORIF for distal humerus fractures between Jan 2023 and Jan 2025 with ≥12 months of follow-up were retrospectively reviewed, excluding non-operative treatment, arthroplasty, percutaneous pinning, external fixation, pathological or high-grade open fractures, and incomplete records. Demographic, clinical, laboratory, and fracture characteristics were systematically collected, and postoperative reduction quality was assessed. Intraoperative and postoperative complications, implant failure, fracture union, and revision surgery were recorded. Continuous variables were analyzed via t-tests or Mann–Whitney U tests, and categorical variables via Fisher’s exact test (p < 0.05).
Results
The mean age was 76 years, 80.9% were female, and the mean BMI was 27.9±3.2. The most frequent fracture patterns were AO/OTA A2 (36.2%) and C3 (23.4%), with triceps-sparing (68.1%) and olecranon osteotomy (25.5%) approaches and medial-posterolateral plating used in 78.7%. Good overall reduction was achieved in 55.3% and good capitellum reduction in 68.1%. Early complications included ulnar nerve palsy 14.9%, implant failure in 19.1%, nonunion in 21.3%, osteonecrosis in 6.4%, and revision surgery in 6.4%. Implant failure may be associated with younger age, lower BMI, higher postoperative extension limitation, and reoperation, while nonunion showed an association with lower BMI and poor reduction quality.
Conclusion
Double-plate ORIF provides adequate fixation and range of motion recovery in elderly distal humerus fractures, even in patients with poor bone quality. Patient-related factors, such as age and metabolic health, appear to be associated with implant failure and nonunion, emphasizing the necessity of comprehensive preoperative evaluation.