The relationship between the trauma-to-surgery interval and results in c-type distal humeral fractures

Abstract

Background: Delayed surgery will lengthen the immobilization time and lead to soft tissue contracture in AO C-Type distal humeral fractures. We aimed to investigate the relationship between the trauma-surgery interval (TSI) and the functional and radiological parameters. Our hypothesis is delay in surgery separately affects functional and radiological outcomes and results worsen as surgical delay increases. In addition, we investigated if there is a breaking time for surgical delay in deterioration of results. Methods: A total of 39 surgically treated C-Type distal humeral fractures between January 2003 and May 2013 were investigated retrospectively. Cases with additional problems to prolong TSI were excluded. Only patients with long TSI due to lack of operating room or lack of implant were included in the study. Two groups were made according to TSI as group I: 0-2 days and group II: 2–5 days. Groups were evaluated according to MEPI (Mayo Elbow Performance Index), elbow joint ROM (Range of Motion), and stability. Also, estimated radiological parameters were arthrosis, heterotopic ossification, avascular necrosis, joint stepping, malunion, and nonunion. Results: There was no correlation between TSI and MEPI score, but there was a moderate positive correlation between the TSI and extension loss, a moderate negative correlation between the TSI and flexion range. We found that three days is a breaking time for surgical delay in deterioration of results. Conclusions: Delay in surgery independently affected the functional and radiological outcomes and results worsen as surgical delay increased. TSI is even ahead of the fracture type in determining the functional results when TSI is three days and above. Delayed surgery more than three days of C2 fractures may result in more inferior functional results than a C3 fracture treated within three days.