Outcomes of Intra-articular Distal Humerus Open Reduction and Internal Fixation Based on Severity of Articular Comminution.

Adolescent distal humerus fractures usually result from high-energy trauma; however, open fractures with associated bone loss are quite rare. Although the Masquelet technique has demonstrated proven success in the reconstruction of lower extremity bone defects, its use in upper extremity periarticular defects, especially in adolescents, has been very rarely reported. This study aims to present the clinical and radiological outcomes of the Masquelet technique in adolescent distal humerus fractures with bone loss. A retrospective review was conducted of patients aged 12-16 years who underwent the Masquelet technique for distal humerus bone defects at a level 1 trauma center. Four patients who met the inclusion criteria were evaluated. Data collected included demographic characteristics, fracture characteristics, defect size, surgical details, time to union, range of motion (ROM), and functional outcomes assessed by the Mayo Elbow Performance Score (MEPS). The mean defect size was 6.4 cm2 (range 4.8-10.2 cm2). The interval between stages averaged 42.7 days. Radiographic union was achieved in all patients at a mean of 13.3 weeks (range 12-15). At 2-year follow-up, the mean elbow ROM was 122.5° (range 110°-130°). MEPS scores were excellent in two patients and good in two patients. No infection or neurovascular complications were observed. Tricortical iliac crest autografts combined with cancellous grafts were used in all cases. The Masquelet technique appears to be a feasible and effective option for the treatment of rare adolescent distal humerus fractures with bone loss. Larger prospective studies are required to clarify optimal graft selection, the use of antibiotic-loaded spacers, and the timing of the second stage in this rare clinical entity.

Perforator flap reconstruction for post-burn flexion contracture of the elbow joint.

Background:Lateral epicondylitis (LE) is commonly treated with corticosteroid injections, which may lead to atrophy of the skin and subcutaneous fat. Surgical intervention becomes necessary in refractory cases, yet the optimal approach in patients with injection-induced soft tissue atrophy remains unclear.Hypothesis/Purpose:This study aimed to compare clinical outcomes and wound-related complications between arthroscopic and open extensor tendon release in patients with LE complicated by corticosteroid-induced soft tissue atrophy. It was hypothesized that the arthroscopic technique would result in superior outcomes and fewer wound-related complications.Study Design:Cohort study; Level of evidence, 3.Methods:We retrospectively reviewed a prospectively collected database of patients who underwent arthroscopic or open extensor tendon release for LE between 2018 and 2024. Inclusion criteria were refractory LE for ≥6 months, visible corticosteroid-related skin and subcutaneous atrophy, and ≥12 months of follow-up. Patients with previous elbow surgery or additional pathologies were excluded. Functional outcomes (Mayo Elbow Performance Score [MEPS] and Quick Disabilities of the Arm, Shoulder and Hand [QuickDASH]) and complication rates were compared.Results:In total, 59 patients were included (arthroscopic: n = 32; open: n = 27). Preoperative demographics and scores were similar between groups (P≥ .272). At a mean 44-month follow-up, the arthroscopic group showed significantly better postoperative MEPS (91.4 ± 3.6 vs 88.8 ± 3.8, P = .009) and QuickDASH scores (14.4 ± 6.4 vs 20.4 ± 9.6, P = .006). Minimal clinically important difference, substantial clinical benefit, and patient acceptable symptom state thresholds were met by a significantly greater proportion of patients in the arthroscopic group across both scoring systems. Wound-related complications occurred in 4 open cases versus none in the arthroscopic group (P = .039). Poor clinical outcomes were more frequent in the open group, although not statistically significant (P = .084).Conclusion:Arthroscopic release provided superior functional outcomes and significantly fewer wound complications compared to open surgery in patients with LE who have corticosteroid-induced soft tissue atrophy.

To compare and rank the clinical outcomes of commonly used surgical strategies for the terrible triad of the elbow (TTE) using a network meta-analysis (NMA). Major databases were searched from inception to September 2025 for comparative studies evaluating different surgical approaches for TTE. Primary outcomes were the Mayo Elbow Performance Score (MEPS) excellent-good rate and complication incidence. Secondary outcomes included elbow flexion-extension range of motion (ROM), forearm rotation ROM, and fracture healing time. A frequentist NMA framework was applied to estimate comparative effects and rank strategies. Fourteen studies involving 866 patients were included. The Lateral + Anteromedial (L + AM) approach demonstrated a higher probability of achieving favorable MEPS outcomes and lower complication rates. The Anterolateral (AL) and Anteromedial (AM) approaches ranked more favorably in restoring flexion-extension and forearm rotation ROM. No significant differences in fracture healing time were observed across strategies. Overall heterogeneity and inconsistency were low. The L + AM approach appears to offer a favorable balance between functional outcomes and complication risk, whereas AL and AM approaches may provide advantages in postoperative mobility. As all included studies were retrospective and heterogeneous in design, these findings should be interpreted with caution. High-quality prospective studies are required to validate these results.

Transposition of the local extensor fascia for elbow lateral collateral ligament reconstruction: Results in a group of competitive athletes.

Total elbow arthroplasty (TEA) has shown favourable outcomes in the management of severely comminuted distal humeral fractures in low-demand elderly patients, leading to its increased use in recent years. Less is known about the outcomes of TEA when used for the failure of either internal fixation or conservative management, particularly whether not performing TEA acutely influences the options for further management if fixation fails. This systematic review aimed to assess the clinical and functional outcomes following TEA when used for the post-traumatic sequelae of a distal humeral fracture, and to compare these outcomes with those in patients with a distal humeral fracture who undergo TEA acutely. MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scopus databases were searched from January 2000 to September 2024 for studies reporting complications, reoperations, the range of motion of the elbow, or functional outcomes following the use of TEA in the management of the post-traumatic sequelae of distal humeral fractures, including those due to failed fixation, nonunion, and post-traumatic arthritis. Demographic and clinical data were collected, descriptive statistics were summarized, and meta-analyses were undertaken to compare the outcomes between salvage and acute TEA. A total of 16 studies were included, with a total of 380 patients who underwent salvage TEA and 251 who underwent TEA as the initial management. Salvage TEA was associated with a significantly higher overall risk of complications (odds ratio (OR) 2.5 (95% CI 1.0 to 5.9)), though the rate of reoperations did not differ from those who underwent TEA acutely (OR 1.4 (95% CI 0.8 to 2.4)). Pooled analyses revealed a similar postoperative range of flexion (mean difference (MD) -2.4° (95% CI -9.1 to 4.3)) and extension of the elbow (MD 1.1° (95% CI -2.3 to 4.5)) and pronation (MD 0.0° (95% CI -1.1 to 1.1)) and supination (MD -0.0° (95% CI -1.0 to 0.9)) of the forearm. However, salvage TEA showed significantly inferior functional outcomes, as assessed by the Mayo Elbow Performance Score (MD 9.7 (95% CI -18.8 to -0.6)). These findings indicate that salvage TEA represents a viable option for the management of post-traumatic sequelae following the teatment of a distal humeral fracture, although patients who underwent salvage TEA had a significantly increased rate of complications and significantly inferior functional outcomes compared with those who underwent TEA acutely.

Efficacy of conservative treatment strategies for partial distal biceps tendon ruptures: a case-control study.

Extra-articular distal humerus fractures account for approximately 16% of all humerus fractures and 3% of adult fractures. These injuries pose significant treatment challenges due to the complex three-dimensional anatomy and the biomechanical demands placed on the distal humerus. The objective of this study was to evaluate the clinical and functional outcomes of extra-articular distal humerus fractures treated with locking compression plates. A prospective study was conducted on 90 patients with extra-articular distal humerus fractures who underwent open reduction and internal fixation using an extra-articular distal humerus plate (EADHP) between June 2020 and March 2023. Patients were followed for an average of 7 months. Functional outcomes were assessed using the Mayo elbow performance score (MEPS), Anderson criteria, and disabilities of the arm, shoulder, and hand (DASH) score. The mean patient age was 45.2 years, with a male predominance (71.7%). Road traffic accidents were the most common cause (81.3%). The average time to fracture union was 10 weeks. The mean MEPS was 84, and the mean DASH score was 15.6. According to the Anderson criteria, 84.4% achieved excellent results and 15.6% achieved good results. Complications included elbow stiffness (12.5%), hardware prominence (6.2%), ulnar neuropraxia (6.2%), infection (3.1%), and heterotopic ossification (3.1%). The EADHP locking compression plate provides excellent stability for extra-articular distal humerus fractures, enabling early mobilization and favorable functional recovery. Its stable construct reduces the risk of implant failure and nonunion, making it a reliable option for these challenging fractures.

Fractures of the distal humerus account for 2-6% of all fractures and pose significant challenges due to articular involvement, comminution, and osteopenia. This study evaluates the functional and radiological outcomes of intra-articular distal humerus fractures (AO Type C) managed with open reduction and internal fixation using orthogonal locking compression plates through a posterior approach with chevron olecranon osteotomy. In this prospective study, 30 patients (20 males, 10 females) with Type C distal humeral fractures (C1 = 10, C2 = 16, C3 = 4) underwent surgical treatment and were followed for a mean duration of 6 months. Causes included motor vehicle accidents (21 cases), accidental falls (7 cases), and assault (2 cases). The mean time to radiological union was 12.7 weeks. Functional outcomes assessed via the Mayo Elbow Performance Score (MEPS), which showed excellent in 12 cases, good in 10, fair in 4, and poor in 4, yielding a 73.3% good to excellent outcome rate. Complications included ulnar nerve paraesthesia (4 cases), superficial infection (4 cases), heterotopic ossification (4 cases), elbow stiffness (2 cases), and hardware prominence (2 cases). Operative management of Type C distal humerus fractures with bicolumn orthogonal locking plates provides stable fixation, facilitates early mobilisation, and results in a high union rate with satisfactory functional outcomes and acceptable complication rates.

Objectives Total elbow arthroplasty (TEA) is often utilized for complex distal humerus fractures, particularly in elderly adults. This systematic review and meta-analysis aimed to evaluate the functional outcomes, complication rates, and implant usage trends associated with primary TEA in the modern era. Methods A systematic literature search was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines across PubMed, Embase, and Cochrane Library through April 30, 2025. Studies were included if they reported outcomes of primary TEA for acute distal humerus fractures in adult patients aged 18 years and older, with a minimum of five patients per study and at least three months of follow-up. Complications and functional outcomes, including Mayo Elbow Performance Score (MEPS), Disabilities of the Arm, Shoulder and Hand Score (DASH), and range of motion, were pooled by performing random-effects meta-proportion meta-analysis. Study-level heterogeneity and risk of bias were assessed, and publication bias was evaluated, with sensitivity analyses performed to evaluate the robustness of findings. Results Twenty-six studies comprising 904 patients were included. The mean patient age was 73.8 years (range: 64 to 81.3 years), and 88% were female. The most commonly used implant was the Coonrad-Morrey prosthesis (65%). Pooled functional outcomes demonstrated a mean MEPS of 85 and a flexion-extension arc exceeding 100°, while the mean DASH score was 31. The overall complication rate was 23%, with the most frequent complications being heterotopic ossification (28%), infection (17%), and neuropathy (13%). The reoperation or revision rate was 8.2%. Conclusion TEA offers favorable functional outcomes for acute distal humerus fractures in elderly patients but remains associated with high complication and reoperation rates. Surgeons can advise patients of a nearly one-quarter complication rate and a nearly one-tenth reoperation rate. Heterotopic ossification, infection, and neuropathy are the most frequently reported complications, emphasizing the need for prevention, refined surgical techniques, and improved implant characteristics.

Background: Elbow dysfunction can impair daily activities and reduce health-related quality of life (HRQoL). This study used the EuroQol five dimensions instrument (EQ-5D) alongside functional scores and treatment priorities to assess HRQoL in patients awaiting elective elbow surgery.Methods: In this prospective study, patients scheduled for elbow surgery from December 2024 onward were enrolled and categorized as having osteoarthritis, stiffness, or instability. HRQoL was measured using the EQ-5D. Multivariable regression was performed with EQ-5D as the dependent variable and waiting time, age, sex, and diagnosis as predictors. Functional outcomes were assessed with the Mayo Elbow Performance Score (MEPS) and Quick Disabilities of the Arm, Shoulder and Hand (qDASH). Patients also indicated whether they prioritized pain relief or improved mobility.Results: Overall, 102 patients were included. The mean waiting time was 204±115 days, and the overall EQ-5D index was 0.67±0.26. Patients with osteoarthritis had the lowest EQ-5D index (0.60±0.29), highest pain levels (2.32±0.48), and greatest depression scores (1.97±0.75). They also showed the lowest MEPS and highest qDASH, with MEPS significantly lower than in patients with instability (P=0.016). The multivariable regression suggested non-significant trends toward lower EQ-5D with longer waiting times (β=–0.00010, P=0.663) and older age (β=0.002, P=0.306). Osteoarthritis patients prioritized pain relief (P=0.026), and stiffness patients prioritized mobility (P=0.021). Conclusions: Although longer waiting times and older age showed non-significant trends toward lower HRQoL, osteoarthritis patients were most affected, with the lowest EQ-5D (0.60) and significantly worse MEPS (P=0.016) than in the other groups. Future studies should test whether preoperative pain or psychological support can mitigate HRQoL decline. Level of evidence: II.

This study aims to comparatively evaluate clinical and radiologic outcomes of lateral humeral condyle fractures (LHCFs) in infants (0 to 12mo), toddlers (1 to 3y), preschool childrens (3 to 5y), and school-age childrens (5 to 12y) with a secondary objective of assessing the prognostic utility of the Normalized Lateral Elbow Swelling-to-Humerus Diameter (N-LES-H) index, particularly for Jakob Type I fractures. A total of 133 pediatric patients treated for LHCFs between 2012 and 2023 were retrospectively reviewed. Patients were stratified by age and treatment modality (operative vs. nonoperative). Fractures were classified per the Jakob system. For Jakob Type I injuries, the N-LES-H index was calculated using AP radiographs. Functional outcomes were measured through the Mayo Elbow Performance Score (MEPS) and Flynn criteria. Radiographic outcomes included deformity (varus/valgus), lateral condylar overgrowth, and avascular necrosis (AVN). Statistical analyses included logistic regression and ROC analysis. Among 133 patients (mean follow-up: 6.2 ± 2.5y), 63 were <36 months (32 conservatively, 31 operatively treated) and 70 were >36 months (34 conservative, 36 operative). An N-LES-H index >1.8 significantly predicted surgical necessity in Jakob Type I fractures (AUC: 0.884, P<0.001). Varus deformity (>5 degrees) and condylar overgrowth were more prevalent in younger surgical patients (P<0.05). MEPS outcomes were excellent in 132 cases. According to Flynn criteria, outcomes were excellent in 114, satisfactory in 16, and poor in 3, with significant group differences (P<0.05). Although complication rates were higher in the <36-month cohort, age-appropriate treatment yielded favorable functional outcomes. Conservative management was effective in selected Type I and II fractures in this group, likely due to greater remodeling potential. The N-LES-H index proved to be a reliable, objective and age-independent tool for treatment stratification in Jakob Type I LHCFs. These findings support the integration of the N-LES-H index into clinical decision-making algorithms and warrant validation through future multicenter prospective studies. Level III-Retrospective comparative study.

BackgroundElbow fractures, including distal humerus, radial head and neck, and olecranon injuries, pose significant surgical challenges due to complex anatomy and the high risk of postoperative stiffness. Early fixation has been advocated to restore alignment and enable early mobilization, but concerns regarding soft tissue readiness and patient optimization often delay intervention. The 48-hour threshold for surgical timing was selected based on biological reasoning-intervening during the early inflammatory phase to minimize periarticular fibrosis-and logistical feasibility within tertiary-care systems, where this window allows adequate preoperative preparation and resource allocation. This study aimed to evaluate the effect of early (<48 hours) and delayed (48 hours-14 days) surgical fixation on functional outcomes and postoperative complications following elbow fractures.MethodsThis prospective observational study included patients aged 12 years and above who presented with acute distal humerus, radial head or neck, or olecranon fractures within 14 days of injury. Only closed or Gustilo-Anderson type I open fractures were included. Patients were classified into early (<48 hours) and delayed (48 hours-14 days) surgery groups. The reasons for surgical delay, medical, logistical, or soft-tissue related, were documented. Functional recovery was assessed using the Mayo Elbow Performance Score (MEPS) at six months, and postoperative complications were recorded. Statistical analysis included t-tests, chi-square or Fisher’s exact tests, and multivariable logistic regression to identify independent predictors of adverse outcomes. A subgroup analysis compared adolescents (12-17 years) and adults (≥18 years) to explore age-related differences in functional recovery and healing. A p-value of <0.05 was considered statistically significant.ResultsOf 177 patients (91 early, 86 delayed surgery), baseline characteristics and fracture patterns were comparable between groups. Early surgery was associated with shorter operative duration (94.5 ± 28.9 vs. 102.7 ± 32.9 minutes, p = 0.004), reduced intraoperative blood loss, and shorter hospital stay (4.8 ± 1.2 vs. 6.1 ± 1.4 days, p < 0.001). The overall complication rate was lower in the early group (12.1% vs. 25.6%, p = 0.021). At six months, patients undergoing early fixation achieved significantly higher mean Mayo Elbow Performance Scores (MEPS) (87.2 ± 8.1 vs. 81.5 ± 9.6, p < 0.001) and a greater proportion of excellent/good functional outcomes (86.8% vs. 72.1%, p = 0.019). Multivariable logistic regression, adjusted for potential confounders such as comorbidities, mechanism of injury, delay cause, and rehabilitation initiation, identified early surgery as an independent predictor of optimal functional recovery (MEPS ≥ 90).ConclusionEarly surgical intervention for elbow fractures, particularly within 24-48 hours of injury, was associated with significantly better functional outcomes, reduced postoperative stiffness, and shorter rehabilitation time compared to delayed surgery. Although overall complication rates did not differ significantly, the early surgery group demonstrated lower incidences of infection and transient neuropraxia, supporting the clinical benefit of timely fixation. These findings underscore the importance of prioritizing early operative management in suitable candidates to optimize recovery, minimize functional impairment, and enhance long-term joint outcomes.

To investigate effectiveness of the bridge combined fixation system (BCFS) for Bado typeⅠchronic Monteggia fractures (CMF) in children. A clinical data of 8 children with Bado type ⅠCMF, who were treated with the BCFS between November 2023 and February 2025, was retrospectively analyzed. There were 6 boys and 2 girls, with a mean age of 7.0 years (range, 4-12 years). The time from injury to operation ranged from 29 to 370 days (median, 68.5 days). Preoperative elbow range of motion was (111.3±17.9)° in flexion, (13.1±13.9)° in extension, (71.9±14.6)° in pronation, and (75.6±13.5)° in supination. Fracture healing time and postoperative complications were observed, and clinical outcomes were evaluated using the Mayo elbow performance score. All incisions healed by primary intention without infection, non-healing of the incision, or iatrogenic nerve injury. All children were followed up 4-18 months (mean, 10.3 months). At last follow-up, the elbow range of motion significantly improved to (142.5±2.7)° in flexion, (2.5±2.7)° in extension, (87.5±2.7)° in pronation, and (88.8±2.3)° in supination ( P<0.05). According to the postoperative Mayo elbow performance score, all cases were rated as excellent. Radiographic review showed no radial head dislocation, nonunion at the ulnar osteotomy site, or elbow stiffness, and no breakage of the BCFS or screw loosening. The fracture healing time ranged from 3 to 6 months, with a median of 4 months. The BCFS was confirmed to be effective in the treatment of pediatric Bado type Ⅰ CMF, with good restoration of elbow function and the advantage of avoiding secondary implant removal surgery.

BACKGROUND Surgical management of distal humerus fractures in hemodialysis patients with an ipsilateral arteriovenous shunt is challenging due to shunt injury and bleeding risks. Treatment selection requires careful patient evaluation and arteriovenous fistula (AVF) preservation. This report describes 2 such cases managed with open reduction and internal fixation using locking plates. CASE REPORT Case 1: A 62-year-old man with chronic renal failure sustained an AO type C1 distal humerus fracture in the shunt-bearing limb. Surgery was performed in the supine position without a tourniquet, using medial and lateral approaches with double locking plates. At final follow-up, elbow motion was 120° flexion, 0° extension, 90° pronation, and 90° supination. Grip strength was 77.3% of the contralateral side. The visual analog scale (VAS), Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) score, and Mayo Elbow Performance Score (MEPS) were 0, 0, and 100, respectively. Radiographs confirmed bone union. Case 2: A 64-year-old woman with chronic renal failure sustained an AO type A2 fracture in the shunt-bearing limb. The same surgical approach was used. At final follow-up, elbow motion was 135° flexion, -5° extension, 85° pronation, and 85° supination. Grip strength was 100% of the contralateral side. The VAS, Q-DASH, and MEPS were 1, 9.09, and 85, respectively. Radiographs confirmed bone union. CONCLUSIONS Locking plate fixation via medial and lateral approaches in the supine position, without tourniquet use, produced favorable outcomes in both cases. This technique may help to preserve AVF function while ensuring stable fixation and satisfactory functional recovery.

ObjectiveTo evaluate the efficacy of closed reduction percutaneous pinning (CRPP) in the treatment of Song V lateral humeral condyle fractures in children.MethodsMedical records of pediatric patients who underwent surgical treatment for lateral humeral condyle fractures at our institution from July 2018 to August 2024 were retrospectively reviewed. Inclusion criteria: (1). Age ≤14 years; (2). Time from injury to surgery ≤3 days; (3). Song V lateral humeral condyle fracture. Exclusion criteria: (1). Open fracture or concomitant fractures; (2). Associated neurovascular injury; (3). Pathological fracture or concomitant metabolic diseases; (4). Incomplete clinical or radiological data; (5). History of previous surgery on the ipsilateral elbow. Patients meeting the criteria were divided into two groups based on surgical approach: open reduction (n = 43) and closed reduction (n = 46). Gender, age, affected side, intraoperative blood loss, and operative duration were recorded. Elbow function was assessed using the Mayo Elbow Performance Score (MEPS) at the one-year postoperative follow-up. Overgrowth of the lateral condyle was evaluated on anteroposterior radiographs by the presence of a prominent lateral spur; overgrowth was defined as a final interepicondylar width (IEW)/initial IEW ratio >1.1.ResultsThe mean age in the closed reduction group was 4.87 ± 1.55 years, compared to 4.53 ± 1.57 years in the open reduction group, showing no statistically significant difference (t = 1.0126, P = 0.314). There were also no significant differences between the two groups in terms of gender distribution (χ² = 2.715, P = 0.099) or affected side (left/right) (χ² = 0.01, P = 0.914). The closed reduction group demonstrated significantly less intraoperative blood loss (1.02 ± 0.15 mL vs. 3.77 ± 3.22 mL; U = 240.5, P < 0.001) and shorter operative duration (52.96 ± 19.52 min vs. 91.84 ± 30.16 min; U = 275.0, P < 0.001). At the one-year follow-up, no significant difference was found in MEPS (99.78 ± 1.02 vs. 99.53 ± 1.45; U = 841.0, P = 0.180). Evaluation of lateral condyle overgrowth also showed no significant difference between the groups (χ2 = 2.46, P = 0.12).ConclusionClosed reduction percutaneous pinning fixation for Song V lateral humeral condyle fractures achieves surgical outcomes comparable to open reduction. However, CRPP offers the advantages of minimal scarring and significantly shorter operative time.

This study aims to compare the efficacy of the bilateral triceps approach (BTA) versus the olecranon osteotomy approach (OOA) with orthogonal double plating in managing Arbeitsgemeinschaft für Osteosynthesefragen (AO) Foundation type C3 distal humeral fractures, providing evidence for selecting optimal surgical approaches and fixation methods. This retrospective analysis included 31 patients with AO type C3 distal humeral fractures treated at the Department of Orthopaedic Trauma, Orthopaedic Center, the First Hospital of Jilin University between June 2018 and May 2024. All patients underwent open reduction and internal fixation with orthogonal double plates placed dorsally on the radial column and medially on the ulnar column. Based on surgical approach, patients were divided into the BTA group (n = 16) and OOA group (n = 15). The parameters evaluated during this study included injury-to-surgery interval, operative time, intraoperative blood loss, postoperative complications (iatrogenic nerve injury, wound infection, elbow stiffness), and Mayo Elbow Performance Score (MEPS) at 6 and 12 months postoperatively. All patients achieved bony union and their fractures healed with complete follow-up. No statistically significant differences were observed in gender, age, or injury-to-surgery interval between groups (p > 0.05). Operative time was significantly shorter in the BTA group compared to the OOA group (p < 0.05). Similarly, there were no significant differences between the groups regarding intraoperative blood loss, postoperative complication rates, or excellent/good rates of MEPS at 6 or 12 months (all p > 0.05). For AO type C3 distal humeral fractures without metaphyseal defects, orthogonal double plating provides rigid fixation enabling early postoperative mobilization. For fractures with intact trochlear articular surfaces (no coronal/horizontal split) where fragments can be directly fixed by distal screws from the plates, the bilateral triceps approach may be prioritized. For severely comminuted trochlear fractures with articular fragmentation (coronal/horizontal split) requiring separate fixation of split fragments with headless compression screws, the olecranon osteotomy approach may provide better exposure.

Distal humerus fractures (DHFs) constitute 2% of all fractures, with open reduction and internal fixation (ORIF) often indicated for treatment. Within ORIF literature exists the triceps-reflecting anconeus pedicle (TRAP) approach: an alternative that offers adequate exposure while preserving key soft-tissue structures hypothesised to improve outcomes. Despite this, TRAP-related findings remain poorly collated and lacking consensus. Thus, this systematic review aims to synthesise TRAP-utilising intercondylar DHF ORIF outcomes to guide and inform surgical decision-making. A PROSPERO-pre-registered query searched PubMed, Ovid-Embase, Cochrane, and Web of Science on June 26th, 2025, for relevant studies. Demographics, range-of-motion (ROM), and complications were among extracted variables. Frequency-weighted means (FWM) and standard deviations, supplemented by narrative synthesis, constituted data analyses. Twelve moderate quality observational studies were included (n = 295; 59.6% male; FWM age 38.7 ± 10.8 years; follow-up 26.1 ± 9.5 months). All patients underwent TRAP approach DHF ORIF for AO type C fractures (C1 = 29.4%; C2 = 40.7%; C3 = 29.9%), most often from falls or motor vehicle accidents. Union was reported in all cases, and at a FWM 15.7 ± 4.7 weeks. FWM Flexion-extension arc was 113.8˚ ± 12.3, prosupination arc was 157.9˚ ± 8.1, and Mayo Elbow Performance Score was 85.5 ± 8.3. The pooled complication rate was 26.5%, with ulnar nerve-related issues (8.8%) and infection (8.5%) most frequent. The TRAP approach to DHF ORIF appears to yield favorable union, ROM, and functional outcomes; however, ulnar nerve-related issues and infection warrant relative caution. Future large, randomised trials are needed to better optimise alternative surgical approach selection strategies. Level III.

ObjectiveThis study aimed to evaluate the effect of an integrated orthopedic rehabilitation program on elbow joint function recovery in patients after surgical treatment for ulnar olecranon fractures, compared to conventional rehabilitation.MethodsA retrospective cohort study was conducted on 87 patients who underwent surgery for ulnar olecranon fractures. Based on the standard of care at the time of admission, patients were assigned to a control group (n=42) receiving conventional rehabilitation or an observation group (n=45) receiving an integrated rehabilitation program. The integrated program comprised preoperative education, standardized in-hospital training, a structured 24-week home-based protocol with phased goals, and monitored follow-up. The primary outcome was the Mayo Elbow Performance Score (MEPS). Secondary outcomes included elbow range of motion (ROM), Activities of Daily Living (ADL) score, Visual Analog Scale (VAS) for pain, and complication rates.ResultsThe observation group showed a significantly higher rehabilitation effectiveness rate (97.78% vs 80.95%, p=0.026). They also achieved superior MEPS (75.31 vs 53.85, p<0.001), ADL scores (62.64 vs 55.17, p<0.001), and lower VAS scores (2.36 vs 4.36, p<0.001). Elbow ROM improvements in flexion, extension, pronation, and supination were all significantly greater in the observation group (all p<0.001). Complication rates did not differ significantly (6.67% vs 9.52%, p=0.924).ConclusionThe integrated orthopedic rehabilitation program is superior to conventional rehabilitation in promoting functional recovery, improving range of motion, enhancing daily living activities, and alleviating pain in patients after ulnar olecranon fracture surgery. However, these findings should be interpreted with caution due to the limitations of a retrospective design and a modest sample size. Integrated rehabilitation represents a highly effective postoperative management strategy for these patients.