A Systematic Review and Meta-Analysis Study in Functional Outcome between Olecranon Osteotomy and Triceps Anconeous Pedicle Elevation in Intercondylar and Supracondylar Humerus Fracture

Abstract

Abstract Background Approximately, 7% of all adult fractures involve the elbow, of these one third (2%) are distal humeral fractures. Articular fractures of elbow are the most difficult one to treat. Because of their complex anatomy, proximity to vital structures, injury patterns, associated osteoporosis in elderly patients and limited space for instrumentation. As far as we know, no previous meta-analysis study has investigated the privilege between olecranon osteotomy and triceps-reflacting anconeous pedicle (TRAP) regarding functional outcome and complications in the treatment of suprachondylar and interchondylar humerus fractures. Therefore, we performed this systematic review and meta-analysis study of this issue. Methods This meta-analysis study included all studies which comparing between TRAP and OO in the treatment of suprachondylar and interchondylar humerus fractures. The literature search was in the Web of Science, PubMed, Scopus, and Cochrane databases using advanced search strategy. The search results was screened using titles and abstracts then full paper. The following data were extracted: country, study design, sample size, baseline characters of included patients, intervention, outcomes, parameters measuring functional outcome as incidence of excellent and good elbow performance, Mayo elbow performance score, duration of operation, blood loss and, complications. The quality assessment was operated by ROBINS-I tool for assessment of risk of bias for non-randomized studies, cohort studies and the Cochrane RoB tool for randomized trials. Results This meta-analysis study included 10 studies. The result of meta-analysis study may be summarized as follow no statistically significant difference between operative time and blood loss during both approaches. No statistically significant difference between both approaches regarding MEPS score, DASH Score, incidence of excellent/good elbow function, supination and pronation. A significant increase in union time, extension deficit (degrees) and incidence of complications after OO approach comparing with TRAP approach. A significant decrease in ROM after OO approach comparing with TRAP approach. Conclusion TRAP approach is a better alternative to olecranon osteotomy approach in the treatment of inter-condylar and supracondylar humeral fracture. TRAP approach has privileges over olecranon osteotomy approach regarding post-operative union time, extension deficit, range of motion and incidence of complications.