{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T06:50:11Z","timestamp":1790232611674,"version":"4.1.0"},"reference-count":25,"publisher":"British Editorial Society of Bone & Joint Surgery","issue":"8","license":[{"start":{"date-parts":[[2015,8,1]],"date-time":"2015-08-01T00:00:00Z","timestamp":1438387200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/online.boneandjoint.org.uk\/TDM"}],"content-domain":{"domain":["online.boneandjoint.org.uk"],"crossmark-restriction":true},"short-container-title":["The Bone &amp; Joint Journal"],"published-print":{"date-parts":[[2015,8]]},"abstract":"<jats:p>The best method of managing a fracture of the distal humerus in a frail low-demand patient with osteoporotic bone remains controversial. Total elbow arthroplasty (TEA) has been recommended for patients in whom open reduction and internal fixation (ORIF) is not possible. Conservative methods of treatment, including the \u2018bag of bones\u2019 technique (acceptance of displacement of the bony fragments and early mobilisation), are now rarely considered as they are believed to give a poor functional result.<\/jats:p><jats:p>We reviewed 40 elderly and low-demand patients (aged 50 to 93 years, 72% women) with a fracture of the distal humerus who had been treated conservatively at our hospital between March 2008 and December 2013, and assessed their short- and medium-term functional outcome.<\/jats:p><jats:p>In the short-term, the mean Broberg and Morrey score improved from 42 points (poor; 23 to 80) at six weeks after injury to 67 points (fair; 40 to 88) by three months.<\/jats:p><jats:p>In the medium-term, surviving patients (n = 20) had a mean Oxford elbow score of 30 points (7 to 48) at four years and a mean Disabilities of the Arm, Shoulder and Hand score of 38 points (0 to 75): 95% reported a functional range of elbow flexion. The cumulative rate of fracture union at one year was 53%. The mortality at five years approached 40%.<\/jats:p><jats:p>Conservative management of a fracture of the distal humerus in a low-demand patient only gives a modest functional result, but avoids the substantial surgical risks associated with primary ORIF or TEA.<\/jats:p><jats:p>Cite this article: Bone Joint J 2015;97-B:1132\u20138.<\/jats:p>","DOI":"10.1302\/0301-620x.97b8.35410","type":"journal-article","created":{"date-parts":[[2015,7,29]],"date-time":"2015-07-29T12:00:13Z","timestamp":1438171213000},"page":"1132-1138","update-policy":"https:\/\/doi.org\/10.1302\/crossmark-policy","source":"Crossref","is-referenced-by-count":59,"title":["Revisiting the \u2018bag of bones\u2019"],"prefix":"10.1302","volume":"97-B","author":[{"given":"S. A.","family":"Aitken","sequence":"first","affiliation":[{"name":"Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. J.","family":"Jenkins","sequence":"additional","affiliation":[{"name":"Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Rymaszewski","sequence":"additional","affiliation":[{"name":"Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0SF, UK."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"42","reference":[{"key":"r1","unstructured":"Aitken SAThe epidemiology of upper limb, lower limb and pelvic fractures in adults.Edinburgh: Department of Trauma & Orthopaedics, University of Edinburgh; 2013."},{"key":"r2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2008.06.005"},{"key":"r3","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.84B6.0840812"},{"key":"r4","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.53B3.425"},{"key":"r5","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1097\/00003086-198601000-00026","volume":"202","author":"Zagorski JB","year":"1986","journal-title":"Clin Orthop Relat Res"},{"key":"r6","first-page":"364","volume":"19","author":"Eastwood WJ","year":"1937","journal-title":"J Bone Joint Surg [Am]"},{"key":"r7","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2013.10.001"},{"key":"r8","doi-asserted-by":"publisher","DOI":"10.1097\/01.blo.0000154010.43568.5b"},{"key":"r9","unstructured":"No authors listed.The Scottish Government: Office for the Chief Statistician SG. Scottish Index of Multiple Deprivation, 2012. http:\/\/www.scotland.gov.uk\/Topics\/Statistics\/SIMD\/SIMDPostcodeLookup. (date last accessed 16 April 2015)."},{"key":"r10","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp14X680545"},{"key":"r11","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"r12","doi-asserted-by":"crossref","unstructured":"Muller MThe Comprehensive Classification of Fractures of Long Bones.Berlin: Springer-Verlag; 1990.","DOI":"10.1007\/978-3-642-61261-9"},{"key":"r13","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198668050-00005"},{"key":"r14","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.90B4.20290"},{"key":"r15","first-page":"1038","volume":"87","author":"Beaton DE","year":"2005","journal-title":"J Bone Joint Surg [Am]"},{"key":"r16","doi-asserted-by":"publisher","DOI":"10.1080\/01621459.1958.10501452"},{"key":"r17","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-004-1764-5"},{"key":"r18","doi-asserted-by":"publisher","DOI":"10.3109\/17453674.2013.784658"},{"key":"r19","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-196951010-00011"},{"key":"r20","doi-asserted-by":"publisher","DOI":"10.1308\/003588413X13629960048352"},{"key":"r21","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.L.01137"},{"key":"r22","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.J.00860"},{"key":"r23","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2012.10.029"},{"key":"r24","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-013-1821-9"},{"key":"r25","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.90B3.18971"}],"container-title":["The Bone &amp; Joint Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/online.boneandjoint.org.uk\/doi\/pdf\/10.1302\/0301-620X.97B8.35410","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/online.boneandjoint.org.uk\/doi\/full-xml\/10.1302\/0301-620X.97B8.35410","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/online.boneandjoint.org.uk\/doi\/pdf\/10.1302\/0301-620X.97B8.35410","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,19]],"date-time":"2022-05-19T11:56:59Z","timestamp":1652961419000},"score":1,"resource":{"primary":{"URL":"https:\/\/online.boneandjoint.org.uk\/doi\/10.1302\/0301-620X.97B8.35410"}},"subtitle":["functional outcome after the conservative management of a fracture of the distal humerus"],"short-title":[],"issued":{"date-parts":[[2015,8]]},"references-count":25,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2015,8]]}},"alternative-id":["10.1302\/0301-620X.97B8.35410"],"URL":"https:\/\/doi.org\/10.1302\/0301-620x.97b8.35410","relation":{},"ISSN":["2049-4394","2049-4408"],"issn-type":[{"value":"2049-4394","type":"print"},{"value":"2049-4408","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,8]]},"assertion":[{"value":"2014-11-04","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-04-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-08-01","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}