Intercondylar fractures of the distal humerus treated with the triceps-reflecting anconeus pedicle approach

Abstract

Treatment choice for displaced, intercondylar fractures of the distal humerus is open reduction and internal fixation (ORIF) through a posterior approach. The triceps-reflecting anconeus pedicle (TRAP) approach, combination of modified Kocher and Bryan-Morrey has been described as a conservative surgical exposure for fixation of the complex intercondylar fractures. Eleven patients with intercondylar fractures of the humerus operated with this approach were reviewed. The mean follow-up was 26 (14-40) months. The aetiology of injuries was mostly fall on the elbow. There were five females and six males and the average age of the patients was 58.3 years (range 16-70 years). According to Müller et al.'s classification; five were Type C1, four were Type C2 and, two were Type C3. At the final follow-up; Type C1 and C2 fractures had a ROM of 116 degrees (range 95 degrees-140 degrees) and, Type C3 fractures had a ROM of 85 degrees which showed limitation of elbow motion. Average humerotrochlear angle is 93.4 degrees (range 90 degrees-98 degrees). Two patients had transient n. ulnaris paraesthesia and one had heterotopic ossification. Our results demonstrate that TRAP approach is extensile enough in treating these complex fractures however both articular reconstruction and fixation can be easily managed without creating an olecranon fracture. No significant triceps weakness and dysfunction was observed after TRAP approach in the treatment of the intercondylar fractures of the humerus.