Surgical treatment of coronal shear fractures: short- to mid-term results and risk factor analysis

Background Coronal shear fractures of the distal humerus are rare but severe injuries. Reconstruction is often challenging, especially in comminuted and multifragmentary cases, which is why many surgeons opt for an elbow replacement in those cases. However, total elbow arthroplasty is associated with a variety of potential problems itself. Therefore, the aim of this study was to present the functional and clinical outcome of coronal shear fractures treated by osteosynthetic reconstruction in a short- to mid-term follow up, and to identify possible risk factors for an inferior outcome. Methods We performed a retrospective follow-up assessment of 51 consecutive patients (30 women and 21 men; mean age, 52,2 years (range 18–78)) who underwent osteosynthetic reconstruction for coronal shear fractures between 2012 und 2022 after a minimum follow-up period of 2 years. The Mayo Elbow Performance Score, Oxford Elbow Score, and Disabilities of the Arm, Shoulder and Hand Score, were evaluated, and all available radiographs were analyzed. All complications and revision procedures were assessed. Bivariate and multivariate regression analyses were performed to identify potential risk factors for a poor outcome following osteosynthetic reconstruction. Results After an average follow-up period of 49 months (range, 24–134 months), the mean Mayo Elbow Performance Score was 90,0 (range, 40–100), the mean Oxford Elbow Score 38,4 (range, 18–48), and mean Disabilities of the Arm, Shoulder and Hand Score 16,7 (range, 0–69). The average range of motion was 136° (range, 100–140°) for flexion, 0° (range, -10-10) for extension, 87° (range, 60–90°) for pronation, and 85° (range, 10–90°) for supination. There was no extension deficit on the injured site. The overall complication and reoperation rates were 35.3% and 27.4%, respectively, with severe elbow stiffness being the most common reason for revision. Increasing Dubberley classification and posterior comminution were significantly associated with a poor outcome and higher rates of complications and revision. Conclusion This short- to mid-term follow up shows good functional results after osteosynthetic reconstruction in coronal shear fractures despite high complication and revision rates. However, increasing Dubberley classification, posterior comminution and the presence of complications show inferior outcome scores. This study shows that osteosynthetic reconstruction can be an option even in comminuted coronal shear fractures. Nevertheless, patient factors need to be considered and an individual decision concerning the surgical treatment is necessary. Patients should be counseled about the high complication rates and inferior outcome with increasing Dubberley classification. Level of Evidence Level III