Intercondylar Fractures Of Humerus Research Articles

Comparative analysis of two double-plate fixation techniques for intercondylar fractures of the distal humerus

This study was aimed to compare the clinical and radiographic outcomes of patients with intercondylar fractures of the humerus treated with orthogonal and parallel plating methods via precontoured plates. This was a retrospective comparative study conducted on 50 adult patients with intercondylar humerus fractures that were surgically treated over an eleven-year period. The patients were divided into two groups: Group A underwent internal fixation via parallel plating, whereas Group B received orthogonal plating. Clinical outcomes were evaluated via the Mayo Elbow Performance Score (MEPS), and the radiographic assessments included time to consolidation, pseudoarthrosis, malunion and hardware removal. Both groups presented similar demographic and preoperative characteristics. The functional outcomes assessed by the MEPS were not significantly different between the groups. Radiographically, comparable healing times and rates of complications, including pseudoarthrosis, malunion and hardware removal, were observed. The study findings suggest that both orthogonal and parallel plating methods yield comparable clinical and radiographic outcomes in the treatment of intercondylar humerus fractures. These results underscore the effectiveness of both techniques and emphasize the importance of further research to elucidate the optimal plating method for specific fracture patterns.

Risk factors of elbow stiffness after open reduction and internal fixation of intercondylar fracture of humerus

To investigate the risk factors of elbow stiffness after open reduction and internal fixation of intercondylar fracture of humerus. From March 2015 to February 2019, 120 patients with humeral intercondylar fractures were treated with open fixation including 59 males and 61 females, aged from 25 to 77 years with an average of(53.5±3.2) years. According to the occurrence of elbow stiffness after operation, 120 patients were divided into stiffness group(37 cases) and control group(83 cases). The related factors of elbow stiffness were analyzed by single factor analysis, and the risk of elbow stiffness after internal fixation of humeral intercondylar fracture was analyzed by logistic regression factor. There were 37 cases of elbow stiffness(stiff group), and 83 cases had no elbow stiffness(control group). The incidence of joint stiffness was 30.83%. There were significant differences between the stiffness group and the control group in age, injury energy, fracture to operation time, AO classification of fracture, open injury and postoperative premature or hyperactivity. Multivariate logistic regression analysis showed that age>50 years old, high energy injury, AO classification of fracture, open fracture and postoperative premature or hyperactivity were risk factors for elbow stiffness after internal fixation of humeral intercondylar fracture. The postoperative mobility and Mayo elbow performance score(MEPS) scores of the postoperative stiffness group were lower than those of the non-stiffness group with statistical significance(P<0.05). There were no significant differences in postoperative mobility and MEPS scores between flexion stiffness and rotation stiffness after humeral intercondylar fracture(P>0.05). In view of the risk factors of elbow stiffness after internal fixation of humeral intercondylar fracture, reasonable operation plan and rehabilitation strategy should be formulated before operation to minimize the incidence of elbow stiffness.

Treatment of Pediatric Intercondylar Humerus Fracture With External Fixation and Percutaneous Pinning After Closed Reduction.

BackgroundIt is uncommon for young children to suffer an intercondylar fracture of the distal humerus. Although many approaches have been described to manage, there is no specific and accepted treatment protocol for such fracture patterns. This study aimed to identify the incidence of intercondylar fracture of the distal humerus in the pediatric population and report the clinical outcome of external fixation and percutaneous pinning in such injury patterns.MethodsPediatric patients under the age of 14 years who had an intercondylar fracture of the distal humerus treated with external fixation and percutaneous pinning between January 2013 and December 2018 at the author’s Wuhan Union Hospital were retrospectively evaluated. The detailed baseline information of the patients, operating time, time to union time, and carrying angle difference (CAD) of the injured extremity were collected. During the follow-up visit, clinical results were evaluated using the Mayo Elbow Performance Score (MEPS) and the Flynn criteria.ResultsA total of eight patients (2 women and 6 men) with an average age of 8 years (5–12 years) who had an intercondylar fracture of the distal humerus (1 C2 and 7 C1) were included. All the patients achieved union, and the average MEPS score was 95 points 24 months after the surgery.ConclusionThe intercondylar fracture of the distal humerus in children is rare, and closed reduction and external fixation is a viable treatment option, especially for the C1 type of fracture pattern.

Treatment of Fracture Distal End Humerus with open Reduction and Internal Fixation with Plate Osteosynthesis

AbstractBackground: Fractures of distal humerus represent one of the most complicated and challenging fractures in the upperextremity. These are rare fractures. Most fractures involve the joint surface, significant proportions are open, and thecomplex three-dimensional geometry of the distal humerus poses a considerable challenge to reconstruction.Objectives: To study the treatment of fracture distal end humerus with open reduction and internal fixation with plateosteosynthesisMethods: A prospective study of 15 consecutive cases of intercondylar fractures of humerus treated by open reductionand internal fixation over two and half years was conducted. These included 12 fresh cases and 3 old cases. Case wisedetailed study was done in 12 cases by noting the age, sex social status, nature of violence and the duration of injury,information regarding medical problems and any local problems, in relation to bone and joint.Results: At follow up, patients were assessed clinically and radiologically, most patients regained fair to good range ofmotion obtained in 3 months time fracture was united in an average of a 10 weeks and olecranon osteotomy in an averageof 8 weeks. Patients were followed up for an average of 9 months, excellent results were found in five cases (33.33%).Good results in five cases(33.33%) and fair results were obtained in three (20%) cases, poor results in two cases(13.33%)Conclusion: Comminuted fractures of distal humerus in the hands of competent surgeon with open reduction, anatomicassemblage and internal fixation of the fragments offer better results in majority of the cases. In young patients the resultsare good and in old patients results fair probably because of good physiotherapy in young and also cartilage changes limitthe functional outcome in the old. Physiotherapy has a great role in the outcome of functional result.

Low-Cost Method for Fixation of Distal Humerus Fracture in Elderly Osteoporotic Individuals: Experience from a Resource-Limited, Tertiary-Care Setting in North India

Introduction: About 7% of adult fractures involve elbow and around 2% involve distal humerus. Conventionally, these are managed by ORIF with plates and screws. Often osteoporosis and communition of fracture fragments is observed in elderly presenting with this pattern of injury. This further complicates the situation for reconstruction and stable fixation which is critical for early mobilisation. We present our fixation method of Joshi’s External Stabilizing System resulting in satisfactory outcome Methods: During study period (August 2017-Oct 2019), total of 19 patients (male=8) were treated at Dr Rajendra Government Medical College, Tanda, Himachal Pradesh, India. Seventeen of them were elderly osteoporotic individuals. Closed reduction was achieved in 7 cases who had displaced supracondylar humerus fracture. Open reduction through triceps splitting approach extending longitudinally up to fascial sleeve of forearm was done in one case of one year old neglected supracondylar humerus fracture and all cases of intercondylar humerus fracture (N=9). Articular visualisation and reduction were achieved after flexing to about 110 degrees and applying longitudinal traction through trochlear notch with the help of ribbon gauge, obviating the need of olecranon osteotomy. Results: Union was achieved in 15 cases; one case was lost to follow-up after 8 weeks. Another case is within 4 weeks follow-up. Elbow movements were initiated on first post-operative day in all. Fracture was classified on basis of A.O classification. Mayo elbow performance score system was done to evaluate the final functional outcome (Table 1). Conclusion: Complications encountered include minor pin-tract infections in 6 patients. In one patient, fracture was noted on 5th post-operative day at proximal level of construct. This was the patient with one year old neglected supracondylar humerus fracture. One patient was lost to follow-up. Others are doing well after a follow-up duration of 218 patient-months.

Intraoperative arthrography monitoring assisted closed reduction and internal fixation for intercondylar fracture of humerus in children

To investigate clinical effects of intraoperative arthrography monitoring assisted closed reduction and internal fixation for intercondylar fracture of humerus in children. From January 2013 to July 2018, 18 children with intercondylar fracture of humerus were treated by operation, including 13 males and 5 females aged from 3 to 12 years old with an average age of (8.50±2.57) years old. According to Toniolo & Wilkinson classification, 8 children were typeⅠand 10 children were typeⅡ. During the operation, closed reduction and internal fixation were performed under the monitoring of intraoperative radiography, open reduction and internal fixation were performed in necessity. Mayo score of elbow joint was used to evaluate clinical effect at 6 months after operation. All children were underwent arthrography monitoring during operation, 5 children were treated with closed reduction and internal fixation for intraoperative arthrography found no fracture of articular cartilage, 11 children by closed reduction and internal fixation because of fracture of articular cartilage involving the joint space with displacement less than 2 mm, and 2 children by closed or open reduction and internal fixation for fracture of articular cartilage surface with displacement above 2 mm, which 1 child with smooth of joint surface was performed closed reduction and internal fixation, 1 child without smooth of joint surface and displacement above 2 mm was performed open reduction and internal fixation. All children were followed up from 8 to 26 months with an average of (20.28±4.40) months. All factures were healed from 6 to 9 weeks with an average of (7.33±0.77) weeks. Postoperative Mayo score of elbowjoint at 6 months was (89.44±11.36), and 12 patients got excellent results, 5 good and 1 poor. One patient occurred partial limitation of flexion or extension of elbow joint. No elbow deformity and other complications occurred. The treatment of intercondylar fracture of humerus in children under monitoring of intraoperative radiography could reduce opertaion injuries and complications, confirm the reduction effect of articular surface of cartilage in time and clearly, and promote recovery of elbow joint function.

English

BACKGROUND Intercondylar humerus fractures and low transcondylar type fractures of distal humeral often require surgical exposure and anatomical reduction of the articular surface as well as stabilization of the medial and lateral columns of the distal humerus. Traditionally, these injuries have been treated surgically with various extensor mechanism-disrupting surgical approaches. These approaches have often led to delayed union or non-union of the olecranon, triceps weakness, and osteotomy-related prominent implants. To avoid these problems, various extensor mechanism-sparing approaches that provide bicolumnar exposure of the distal part of the humerus have been described, including triceps-splitting and reflecting techniques. The paratricipital approach was developed to avoid the problems of olecranon osteotomy approach for non comminuted distal humerus fractures. The purpose of this study was to compare the paratricipital approach with olecranon osteotomy and evaluate their effects on the functional outcomes of intercondylar fractures of the distal humerus managed with open reduction and internal fixation (ORIF) by reviewing 38 cases of intercondylar distal humerus fractures surgically managed with either of the approaches during 2015 - 2017. METHODS The retrospective study was conducted at our institution, R.G. Kar Medical College, Kolkata from May 2015 to May 2017. OA type C1 and C2 fractures were included in the study. Type C3 fractures were excluded from the study. Distal humeral open reduction and internal fixation (ORIF) was performed with either orthogonal or parallel plate constructs in 38 patients, where paratricipital approach was used in 21 patients and olecranon osteotomy was done for 17 patients. RESULTS Patients in the paratricipital approach group seems to have better range of motion in terms of flexion and extension. Moreover, mayo elbow performance score (MEPS) of the paratricipital group is better than that of olecranon osteotomy group, even more so in younger age groups. CONCLUSIONS We found that ORIF via the paratricipital approach would confer better functional outcomes for simple intra-articular distal humerus fractures in patients of all age groups. KEYWORDS Distal Humerus Fracture, Paratricipital, Olecranon Osteotomy

Functional Outcome of Intercondylar Distal Humerus Fractures Surgically Treated with Open Reduction and Internal Fixation with a Principle Based on Orthogonal Plating Technique

Introduction: Owing to the complex articular structure, paucity of metaphyseal bone and thin soft tissue covering, treatment of intra-articular distal humerus fractures still pose challenge to surgeons. Although it comprises 2% of all fractures the massive complication rate to the treatment is worrisome. This study aims to evaluate the outcome of surgical treatment of these fractures by open reduction and internal fixation by dual orthogonal plates.&#x0D; Objectives: The objective of the study is to evaluate the functional outcome of intercondylar humerus fractures managed with open reduction and internal fixation with orthogonal dual plating technique.&#x0D; Methodology: Eighteen patients (19 – 68 years old) with AO/OTA type 13C fractures were evaluated after surgery for one year with MEPS and range of motion. Complications were categorized as major or minor complications. Functional comparisons were made between simple articular type C1/C2 and complex articular type C3 fractures at one year.&#x0D; Result: There were 2 (11.11%) type C1 fracture and 8 (44.44%) each in type C2 and C3 fractures. Eight (44.44%) patients obtained excellent, 7 (38.89%) obtained good and 3 (16.7%) obtained fair results. There was no poor outcome. Average MEPS score was 83.33 and there was no significant between the subgroups (p = 0.07). The average flexion was 118.06° and it was significantly impaired in type C3 fractures (p = 0.03). Three patients obtained full extension, and remaining patients had mean extension deficit of 12°. Average arch of motion was 108.06° with significant difference between two subgroups (p = 0.008). The mean arc of motion for supination-pronation was 154.44°. There was 5 minor and 2 major complications (total - 38.9%).&#x0D; Conclusion: The surgical management with open reduction and internal fixation by dual plates in orthogonal configuration for the intercondylar distal humeral AO type C fractures has good or excellent functional outcome in majority of the patients.

Management of type 13C2 distal humerus fractures by olecranon osteotomy approach versus triceps sparing approach-our experience with sixty cases.

Intercondylar humerus fractures (AO type 13C), though less common (less than 1%), are increasing over the last few years. Open reduction and internal fixation (ORIF) of these fractures are now well recognised and preferred management. These fractures are principally approached from posterior side and various posterior approaches have been mentioned. Triceps sparing is a relatively newer approach for fixation of these fractures. Here, we are ascertaining the outcomes of triceps sparing approach and olecranon osteotomy approach and also investigating the preferred approach in various age groups. A level III non-randomized retrospective comparative study was conducted with a total of 60 patients belonging to AO type 13C2 in the age group of 16-70 years, operatedupon during the period of September 2013 to March 2019. They were analysed for various outcome measures and complications. MEPS and DASH were used to determine outcome. Out of a total of 60 patients (mean age 37.52 years), 28 were in olecranon osteotomy (OO) group and 32 were in the triceps sparing (TS) group. The mean operative time for group OO was 93.11 ± 8.78 minutescompared with group TS where it was 77 ± 4.64 minutesand the difference was statistically significant. Similarly, blood loss was 224 ± 46 ml in group OO compared with 197 ± 39 ml in group TS and it was also statistically significant. The average MEPS score was slightly better in the group TS (86.56 ± 10.66) compared with group OO (83.57 ± 10.96), though not statistically significant. Similarly, DASH score was 35.72 ± 8.35 in group TS and 35.32 ± 8.89 in group OO. The MEPS score was excellent (≥ 90) in 12 patients of group OO and 16 patients of group TS, good (75-89) in 11 patients of each group and fair (60-74) in 5 patients of each group. The patients in the age group of ≥ 60 years tend to have inferior functional outcomes, though not statistically significant, when treated with triceps sparing approach compared with olecranon osteotomy approach. In conclusion, we found that, compared with the olecranon osteotomy technique, better results though not statistically significant, can be expected with triceps sparing approach while treating type C2 distal humerus fractures in younger patients without significantly compromising the articular reduction or impairing stability of fracture fixation.

Management of intercondylar humerus fracture using jess fixator in adults: A hospital based prospective study

Introduction: Intercondylar fracture of distal humerus is one of the difficult fracture involving the humerus in adults. Intercondylar fracture distal humerus in adults are difficult to manage due to complex anatomy of elbow. We present a method of surgical treatment of intercondylar humerus fracture in adults by open reduction with JEES fixator and to evaluate functional outcome and associated complication with application of JESS fixator.Materials & Methods: It is Institutional based, prospective study carried out from June 2018 to May 2019.Twenty cases of intercondylar distal humerus fracture were reduced and fixed with K-wire and finally JESS was applied. Patient were follow up at 1week, 4weeks, 6weeks & 12weeks and clinically evaluated with Mayo’s elbow performance score. Results: According to AO classification 4 cases had C1 fractures, 14 cases had C2 fractures and and 2 cases had C3 fractures. 3 cases had open injury among which two were of C2 and 1 were C3 type. All cases were operated using paratricipital approach and average duration of JESS application was 7 week and mean follow up duration was 9 months. Irrespective of injury pattern 9(45%) cases showed excellent results, 7(35%) showed good results, 3(15%) cases showed fair results and 1(5%) case showed poor results.Discussion: The goal of intercondylar fracture management by JESS technique is to achieve early range of motion of anatomically align joint. Conclusion: This study shows comparatively good results using JESS fixator. This procedure is viable alternative option to ORIF dur to its simplicit, cost-effectiveness and easy implant removal on day care basis.

The role of open reduction and internal fixation in the treatment of the intercondylar fractures of humerus

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Inter-condylar fractures represent one of the most complicated and challenging fractures in the upper extremity. The results of managing these fractures non-operatively are limited by failure to get anatomical reduction and early mobilization, which often results in painful stiff elbow and/or pseudo-arthrosis. The objective of this study was to evaluate and analyse the role of open reduction and internal fixation in inter-condylar fractures of distal humerus.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt;&lt;strong&gt; &lt;/strong&gt;The present study was done in Malla Reddy Institute of Medical Sciences between June 2014 and June 2017. Out of 34 cases of intercondylar fractures of humerus admitted during the period, 25 patients were selected for the study that satisfied our inclusion criteria. Three patients out of those selected could not be included in the study as one had cardiac issues pre-operatively, one refused surgery and one was lost to follow up.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Our study included 22 patients, 14 male and 8 female patients. Their average age was 41.4 years. The fractures were classified as per the AO classification. There were B1-3, B2-1, C1-6, C2-5, C3-7 fractures. Both compound and closed fractures were included. All the patients were operated by posterior olecranon Chevron osteotomy approach by a senior faculty member. Twenty two patients who satisfied our inclusion criteria were treated, followed up and the results analyzed using Cassabaum’s scale of elbow function we had 86% of excellent to good results. Our results are comparable with other similar studies.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Posterior olecranon approach was found to be of most satisfactory approach by us. It allows good exposure of the joint and the ulnar nerve.&lt;/p&gt;

Evaluation of Results of Intercondylar Fracture of Humerus in Adults Treated by Various Surgical Modalities

Evaluation of Results of Intercondylar Fracture of Humerus in Adults Treated by Various Surgical Modalities

Is anterior transposition of ulnar nerve beneficial during open reduction and internal fixation for intercondylar humerus fractures

To compare activity, function and postoperative ulnar nerve function of elbow joint by anterior transposition of ulnar nerve or not during open reduction and internal fixation for intercondylar humerus fractures. From January 2013 to May 2017, 168 patients with intercondylar humerus fractures were treated surgically with open reduction and internal fixation (ORIF). The patients were divided into anterior subcutaneous transposition group and simple decompression group according to handling method of ulnar nerve. There were 48 patients in transposition group, including 23 males and 25 females with an average age of (42.5±15.7) years old ranging from 14 to 77 years old, and ulnar nerve treated enough free and anterior subcutaneous transpostion after reduction of intercondylar humerus fractures; while there were 120 patients in simple decompression group, including 62 males and 58 females with an average age of (43.4±17.3) years old ranging from 14 to 81 years old, ulnar nerve returned to sulci nervi ulnaris. Activity of flexion and extension of elbow joint, range of rotation of forearm were recorded at the latest following-up, Mayo score of elbow joint was used to evaluate clinical effect, McGowan grading was used to assess dysfunction of unlnar nerve. There was 1 patient delayed union, and 2 patients occurred joint stiffness in transposition group; while 1 patient suffered from incision infection, 1 fracture nonunion, and 4 joint stiffness in simple decompression group; and there was no statistical difference between two groups(P>0.05). Forty-eight patients in transposition group were followed-up from 12 to 59 months with an average of (32.2±14.2) months, activity of flexion and extension of elbow joint was (116±28)°, range of rotation of forearm was (152±12)°, MEPS score was 88.6±11.6; and 28 patients got excellent results, 16 good, 3 moderate and 1 poor. There were 17 patients occurred injury of ulnar nerve, and 7 patients still occurred dysfunction of ulnar nerve, and 6 patients were grade I, 1 patient was grade II according to McGowan grading. In simple decompression group, there were 120 patients were followed-up from 13 to 61 months with an average of (32.0±14.9) months, activity of flexion and extension of elbow joint was (119±27)°, range of rotation of forearm was (154±16)°, MEPS score was 88.9±12.5; and 67 patients got excellent results, 44 good, 7 moderate and 2 poor. There were 42 patients occurred injury of ulnar nerve, and 22 patients still occurred dysfunction of ulnar nerve, and 18 patients were grade I, 4 patients were grade II according to McGowan grading. There were no statistical differences in following time, activity of flexion and extension of elbow joint, range of rotation of forearm, MEPS score and dysfunction of ulnar nerve. Whether anterior transposition of ulnar nerve or not has no clarified effects for open reduction and internal fixation for intercondylar humerus fractures.

Comparative study of triceps reflecting anconeous pedicle approach (TRAP) versus olecranon osteotomy approach for open reduction internal fixation of supracondylar and intercondylar fractures of humerus

Introduction: Approximately, 7% of all adult fractures involve the elbow, of these approximately, one third (2%) are distal humeral fractures. Articular fractures of elbow are the most difficult one to treat. Currently the olecranon osteotomy approach is the most commonly used. O’Driscoll has described a triceps reflecting anconeous pedicle approach (TRAP) that avoids an osteotomy. Objectives: To evaluate and compare the results of TRAP approach and olecranon osteotomy approach in open reduction internal fixation of supracondylar intercondylar fracture of humerus in term of Mayo Elbow Performance Score. Methodology: The present study was a comparative interventional study on patients with intercondylar fracture of humerus admitted in department of Orthopaedics, S.M.S. Hospital, Jaipur during Jan 2012 to Oct 2013. Total 36 patients were taken, out of them 18 were in group-A (operated by olecranon osteotomy approach) and 18 were in group-B (operated by TRAP approach). Results: Duration of surgery was considerably more in group B (1.36 ±. 067 hours) compare to group-A (1.26 ±. 096 hours). That was statistically significant. Mean duration for fracture union in group-A was 13.56 ± 2.007 weeks, while it was 12.56 ± 1.504 weeks in group-B. There was no statistically significant difference. Average of flexion was 110.56 ± 18.86 degrees and 112.78 ± 21.91degrees in group-A and group-B respectively shows there was no significant difference between two groups flexion. Average of extension lag was 19.72 ± 14.70 degree in group-A and it was 12.22 ± 11.90 degree in group-B shows there was no statistically significant difference between two groups extension lag. The mean elbow arc of motion in group A was 90.83 ± 30.35 degrees and in group B was 100.56 ± 28.28 degrees. There was no statistically significant difference. We observed that 3 patients of group-A and 1 patient of group-B had superficial infection during first 2 weeks after surgery. One patient of group-A had deep infection. The average Mayo Elbow Performance Score in group-A was 84.17 ± 16.382 and in group-B was 87.78 ± 14.061. P-value was >.05 (0.483) show that there was no statistically significant difference between two groups MEPS. Overall 29 patients (80.55%) out of 36 shown excellent and good results with conclusion that there is no statistically significant difference between results of two groups.Conclusion: TRAP approach is comparatively better than osteotomy approach. TRAP approach allows stable Fracture fixation, with the advantage of intact olecranon. The approach permits aggressive postoperative elbow rehabilitation.

Evaluation of surgical treatment of inter-condylar humerus fracture with olecranon osteotomy approach

Background: Inter-condylar fracture distal humerus in adults often pose a challenge to orthopaedic surgeons because of the complex anatomy, fracture pattern and limited bone stock of this region. Adequate exposure of the articular surface of the distal humerus and elbow joint is essential for operative stabilisation of complex distal humerus fracture. Various operative approaches have been recommended to access this difficult region which includes triceps splitting, triceps reflecting and trans-olecranon approaches though each approach has its own advantage & disadvantage. Olecranon osteotomy approach provides better visualization of complex intra-articular fractures, enabling accurate reduction and fixation.Aim of this Study: To assess the functional outcome of intercondylar humerus fracture with olecranon osteotomy approach. Study design: prospective studyMaterial and Methods: Sixty patients of inter-condylar fracture humerus fulfilling the inclusion criteria were treated with internal fixation with various implants with olecranon osteotomy via posterior approach. Preoperative and postoperative radiograph measurements were taken and fractures were classified according to the AO system. All patients were operated through posterior trans-olecranon approach. Elbow exercises were started at third postoperative week. Patients were followed at three weeks and thereafter monthly, with clinical examination and x-rays. Results: The average ROM on follow up after 6 weeks was flexion up to 140o and extension upto 5o of elbow flexion. No cases of olecranon or distal humerus non-union were reported. Conclusions: Posterior surgical approach with olecranon osteotomy provides optimal exposure of the intra articular aspect of distal part of humerus and among them olecranon osteotomy gives the best exposure of the articular surface and there by better reduction and internal fixation which in turn gives better stability and good range of motion as compared to other approaches.

Triceps Anconeus Sparring Approach Versus Olecranon Osteotomy in Treatment of Intercondylar Fracture Humerus

AbstractBackground: Intercondylar fracture humerus needs early treatment, anatomical reduction, rigid fixation and early ROM. This study hypothesized that Intercondylar fracture humerus better approached by olecranon osteotomy for comminuted types & by triceps anconeus sparring for simple two parts intercondylar fracture humerus.Aim of Work: Is to compare classic olecranon osteotomy approach with triceps anconeus sparing approach (TRAP) in open reduction and internal fixation of intercondylar fracture humerus patients; regarding exposure of fracture site, operative time, post-operative pain, union time, return to pre fracture range of motion of elbow joint and complications rate. Com-paring our results to the published series in the literatures.Patients and Methods: A clinical study was conducted From January 2012 to October 2015. In this study, forty patients with intercondylar fracture humerus were treated by ORIF using triceps anconeus sparing and olecranon osteotomy approaches. Age ranges from 25 to 60 years. Elbow mayo score and muscle power used for scoring & follow-up period 6 months.Results: All patients were evaluated pre-operatively and post-operatively for Elbow mayo function score, wolf law for triceps power were completed at 1, 3 & 6 months. Olecranon osteotomy gave better results in comminuted intercondylar fractures but triceps sparring was better in simple two part intercondylar humerus fractures especially in young patients.

Early functional outcome of intercondylar humerus fractures fixed with precontoured dual plating in inverted Y-Fashion

Early functional outcome of intercondylar humerus fractures fixed with precontoured dual plating in inverted Y-Fashion

Treatment of intercondylar fracture of the humerus through internal and external elbow approach or elbow posterior olecranon osteotomy approach

To investigate the efficacy, advantages and disadvantages of internal and external elbow joint approach and olecranon osteotomy approach for the treatment of intercondylar fracture of humerus. From October 2012 to May 2016, 18 cases of intercondylar fracture of humerus were treated by operation including 12 males and 6 females with a mean age of 33.5 years old (ranged from 4 to 56 years old); 8 cases were operated by internal and external elbow joint approach, 10 cases were operated by olecranon osteotomy approach. According to AO classification, 3 cases were type C1, 8 cases were type C2, 7 cases were type C3. All patients were excluded from neurologic and vascular injuries. All patients were followed up from 12 to 26 months with an average of 15 months. The incision healed well and no heterotopic ossification was found. According to the modified Cassebaum elbow function score, the result was excellence in 14 cases, good in 3 cases, fair in 1 case. According to the fracture type, the appropriate surgical approach and fixation were selected in order to get anatomic reduction. Rigid fixation, and early functional exercise is important condition for successful operation and satisfactory functional recovery in intercondylar fracture of the humerus.

Modified osteotomy of olecranon for the management of inter-condylar fracture of the humerus

To explore the surgical method and clinical outcome of modified osteotomy of olecranon for the treatment of inter-condylar fracture of humerus. From May 2007 to December 2012, 32 patients of intercondylar fracture of humerus were treated surgically through the approach of modified osteotomy of olecranon. The patients were 21 males and 11 females with a mean age of 46.3 years (ranged 18 to 65 years). Nineteen fractures occurred on the right extremity and 13 on the left extremity. According to the AO classification, type C1 fracture was found in 7, C2 in 11 and C3 in 14. Five patients suffered from open fracture (Gustilo type Iin 3, type II in 2). Other fractures occurred in 6 patients and the primary injury of nerve occurred 6. The healing of the osteotomy was evaluated with physical examination and plain X-ray film, and the function of elbow was assessed according to Cassebaum scale. All the patients were followed from 9 months to 5 years(average, 1.9 years). All the osteotomies healed at 7.4 weeks averagely after operation, and no nonunion, delayed union, fracture of ulna olecranon were found. Two cases had little pain on the elbow, heterotopic ossification occurred in 2 cases and cutting bone block loosed in 1 case. The function of the elbow showed excellent in 19 cases, good in 8, fair in 4 and poor in 1. The use of the approach of modified olecranon osteotomy for surgical management of intercondylar fracture of humerus has some advantages, it provides satisfactory stability with simple technical procedures avoiding inter-articular invasion, and it facilitates rehabilitation exercises and providing good results with low complication rates.

Modified anconeus flap approach for intercondylar humerus fractures

Objective To report a new surgical approach(modified anconeus flap approach)in which the anconeus and part of triceps are reflected in the treatment of distal intercondylar humerus fracture(AO type C). Methods To design the modified anconeus flap approach, the anatomy of the distal tendon of the triceps brachii and the anconeus was studied using 15 cadaveric adult specimens(30 sides). The new surgical approach was compared with the triceps-reflecting anconeus pedicle(TRAP)approach in terms of the area of exposure at the distal humeral articular surface. Furthermore, the new surgical approach was applied in 16 patients who had been treated for intercondylar humerus fracture(AO type C)from May 2005 to May 2013. The clinical outcomes were evaluated using the Mayo elbow performance score(MEPS)and Broberg-Morrey scoring systems. Results The blood supply and innervation of the anconeus was interrupted minimally during incision along the radical edge of triceps tendon. The area of exposure at the distal humeral articular surface provided by the part triceps and anconeus reflecting approach and the medial humerus approach was 42. 66% ±0. 03% at the elbow flexion from 0° to 50°. This was significantly smaller than that provided by the TRAP approach(46. 11% ± 0. 03%)(P< 0. 05). Of the 16 patients, 15 obtained complete follow-ups from 6 months to 4 years(average, 16. 5 months). The mean MEPS at the last follow-up was 90. 5 points(range, from 82 to 93 points), with 10 excellent and 4 good cases and one poor case. The Broberg & Morrey score system showed 11 patients with no articular cartilage degeneration(level-0), 3 patients with level-1 degeneration, and 2 patients with level-2 degeneration. Conclusion The modified anconeus flap approach proposed in the present study provides clear surgical vision and needs no olecranon osteotomy or olecranon dissection or ablation of the major triceps brachii tendon for intercondylar humerus fractures, thereby leading to early active motion and satisfactory clinical outcomes. Key words: Humeral fractures; Autopsy; Therapies, investigational; Surgical approach