Management of intercondylar fractures of the humerus by triceps-reflecting anconeus pedicle (TRAP) and olecranon osteotomy approaches- A comparative study

Abstract

IntroductionIntercondylar fractures of distal humerus are uncommon and pose a considerable challenge to even the most experienced orthopaedic surgeon. Our study aimed at comparing one described surgical approach to fix them, the TRAP approach (Group TR), which involves elevation of a flap comprising of triceps and anconeus from distal to proximal, with the more popular olecranon osteotomy approach (Group O). Material and methodIn this study, 35 patients in Group O were compared with 32 patients in Group TR. Both the groups were comparable in terms of age, gender, duration of injury and degree of comminution of the fracture. Results were compared in terms of union, arc of motion, flexion contracture, overall flexion achieved and triceps strength. Functional evaluation was done using the Mayos’ elbow performance score (MEPS). ResultsPatients were followed for a minimum of 18 months. Fracture union was seen at or before 6 months in all the patients of both the groups except in 3 cases of Group O and 2 of Group TR where it was seen at 9 months. Average time to union was comparable in both the groups. In all of them except 3 in group O and 4 in Group TR, the fractures united with intraarticular step off of less than 2 mm. In Group TR, the average arc of motion was 114.5 (SD 14.6) with a mean degree of flexion of 121.9 (SD 12.1) and extension of 7.3 (SD 5.6). In Group O, the arc of motion averaged 113.6 (SD 18.9) with a mean degree of flexion of 124.1 (SD 13.3) and extension of 10.6 (SD 7.3). ConclusionAlthough technically demanding, TRAP exposure can prove to be as effective as olecranon osteotomy approach and can be used as an approach of choice for fixation of these fractures.