Olecranon Osteotomy Approach Research Articles

Postoperative dorsal step-off predicts olecranon osteotomy union: a retrospective cohort study.

Olecranon osteotomy has been associated with loss of reduction, nonunion, implant failure, and migration of wires. We aim to evaluate quality of reduction of the osteotomy site as a predictor of olecranon osteotomy nonunion. One hundred and twenty-five distal humerus fractures that underwent open reduction internal fixation (ORIF) were reviewed. Amount of dorsal step-off was measured from the lateral radiograph from the second postoperative visit. A receiver operating curve (ROC) analysis was used to assess the predictability of nonunion based on dorsal displacement of the olecranon osteotomy. Between 2014 and 2022, 36 patients underwent a chevron olecranon osteotomy (29%). Of the 36 patients, 7 (19%) failed to successfully unite at the osteotomy site. Two experienced aseptic nonunion, 2 were malreduced leading to nonunion, 2 malunited, and 1 had persistent fracture lines following poor osteotomy cut. Patients that developed nonunion had a mean dorsal displacement of 3.87mm versus 1.15mm (p < 0.001). The ROC demonstrated excellent prediction for nonunion based on displacement (AUC = 0.896, p = 0.002). Youden's index was determined at a sensitivity of 86% and a specificity of 73% corresponding to a dorsal step-off of 2.07mm. This finding was confirmed on multivariate logistic regression showing a step-off over 2.07mm is an independent predictor of olecranon osteotomy nonunion (p = 0.021). A malreduction resulting in a dorsal step-off larger than 2.07mm is predictive of olecranon osteotomy nonunion or malreduction. Therefore, the success of the olecranon osteotomy approach is directly dependent on quality of anatomic reduction. III; Retrospective Cohort Study.

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 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.

Clinical outcomes of triceps reflecting anconeus pedicle and olecranon osteotomy approach for distal humerus intercondylar fractures.

The preferred treatment for distal humeral intercondylar fractures is open reduction and internal fixation. While there is consensus about the posterior approach, several posterior approaches have been developed. It is debatable as to which approach is best. To compare triceps reflecting anconeus pedicle (TRAP) and olecranon osteotomy approaches for internal fixation of distal humeral intercondylar fracture. In total, 40 cases of Arbeitsgemeinschaft für Osteosynthesefragen/Association of the Study of Internal Fixation type C, closed, and Gustilo type I intercondylar humeral fractures were included. Patients ranged in age from 18 years to 70 years. The patients were randomized into two groups: TRAP group and olecranon osteotomy group, with 20 cases in each. All were followed up at 6 wk, 3 months, 6 months, and 12 months. Functional outcomes were measured in terms of flexion-extension arc, Disabilities of Arm, Shoulder and Hand score, and Mayo Elbow Performance Score. The mean age was 43.2 years in the TRAP group and 37.5 years in the olecranon osteotomy group. The mean operative time and mean duration of hospital stay in the TRAP group were significantly higher than in the olecranon osteotomy group (119.5 vs 111.5 min and 9.85 vs 5.45 d, respectively). The mean arc of flexion-extension, Disabilities of Arm, Shoulder and Hand score, and Mayo Elbow Performance Score were comparable without any significant difference in the groups at the 12-month follow-up (107.0 vs 106.2, 18.3 vs 15.7, and 84.2 vs 86.2, respectively). Ulnar paresthesia and superficial infections were comparable in both groups (2 cases vs 3 cases and 3 cases vs 2 cases, respectively). Hardware prominence was significantly higher in the olecranon osteotomy group, mostly due to tension band wiring. Both approaches were equivalent, but there is a need for further study including higher numbers of subjects and longer study duration to prove the benefits of one approach over the other.

Comparison of clinical outcomes between the olecranon osteotomy approach and the Bryan-Morrey approach for total elbow arthroplasty.

This study aims to investigate the clinical efficacy of the olecranon osteotomy approach and the Bryan-Morrey approach in total elbow arthroplasty (TEA). In this retrospective study, 49 patients with elbow disease were treated with TEA. A total of 22 patients with TEA by olecranon osteotomy approach were designated as group A, and 27 patients with TEA by Bryan-Morrey approach were designated as group B. There were 22 males and 27 females, aged 32-82years with a mean age of 62years. There were 44 cases of unilateral elbow joint, including 27 cases on the left elbow and 17 cases on the right elbow, and 5 cases of the bilateral elbow joint. There were 6 cases of osteoarthritis (7 elbows), 18 cases of rheumatoid arthritis (22 elbows), 14 cases of traumatic arthritis (14 elbows), 7 cases of distal humeral fractures (7 elbows), and 4 cases of elbow tuberculosis (4 elbows). For each group, we recorded the operative time, intraoperative bleeding, elbow flexion, extension, pronation, supination, postoperative complication rates, and Mayo Elbow Performance Score after surgery. Operative time and intraoperative bleeding were less in group A than in group B (53-120min [70 (62.5, 78) min] vs. 64-105min [77 (73, 87) min], and 10-200ml [50 (20, 90) ml] vs. 5-250ml [100 (50, 150) ml], P<.028). The elbow flexion, pronation activity, and Mayo Elbow Performance Score were higher in group A than in group B, [(121±12)° vs. (112±10)°, 85 (85,85)° vs. 80 (77,85)°, and (94±3) points vs. (91±4) points, P<.036], while elbow extension and supination activity and complication rates were not statistically significant in either group. Compared to Bryan-Morrey approach, the olecranon osteotomy approach to TEA provides adequate visualization, saves operative time and reduces bleeding, provides better flexion activity, effectively improves elbow function, and achieves satisfactory clinical outcomes.

Intra-articular distal humerus fracture – TRAP or olecranon osteotomy

: Intra-articular distal humeral fractures can be approached in a variety of ways. The purpose of this study is to evaluate and compare the functional outcomes of two approaches: one with olecranon osteotomy and other with triceps-lifting approach; for the treatment of intra-articular distal humeral fractures.: In this study, 10 patients in Group A were compared with 10 patients in Group B. 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 operative time, hospital stay, union, range of motion and complications. Functional evaluation was done using the Mayos’ elbow performance score (MEPS).: Patients were followed for a minimum of 12 months. Fracture union was seen at or before 4 months in all the patients of both the groups, except in 1 case of Group A where it was seen at 7 months. Average time to union was comparable in both the groups. In Group A, mean range of flexion was found to be 118 degrees (SD 7.33) and extension lag was found to be 11 degrees (SD 3.84). In Group B, mean degree of flexion was found to be 118.25 (SD 4.94) and extension loss of 12 degrees (SD 4.70). Average range of motion was comparable in both groups. There were no significant differences noted between the two groups in terms of mean MEPS (p= 0.573). The overall complication rate was 40% in the TRAP group and 30% in the olecranon osteotomy group.: Intra-articular distal humerus fractures mandate surgical fixation for best functional outcomes. Although technically demanding, TRAP exposure can prove to be as effective as olecranon osteotomy approach. Both approaches appear to yield no significant differences in clinical and functional results for intra-articular distal humerus fracture management.

Olecranon osteotomy approach for Dubberley type Ⅲ coronal fractures of the distal humerus

To retrospectively analyze the clinical efficacy of olecranon osteotomy approach in the treatment of Dubberley type Ⅲ coronal fractures of the distal humerus and summarize the treatment experience. From January 2016 to June 2020, 17 patients (5 males and 12 females) with Dubberley type Ⅲ coronal fractures of the distal humerus were treated by olecranon osteotomy approach. The age ranged from 37 to78 years old with an average of (58.5±12.9) years old. According to Dubberley classification, there were 5 cases of type Ⅲ A and 12 cases of type Ⅲ B. The curative effect was evaluated using the Borberg-Morrey elbow function score. The flexion, extension and rotation range of motion of the elbow joint, complications and postoperative imaging evaluation were recorded. All the 17 patients got bony union. The follow-up time ranged from 12 to 33 months with an average of (15.6±5.6) months. There was 1 case of ischemic necrosis of capitulum humeri, 2 cases of traumatic arthritis and 1 case of heterotopic ossification, 1 case of malunion of fracture. The range of motion was (114.80±19.50) °. The Broberg-Morrey score was 85.3±8.2, excellent in 5 cases, good in 9 cases, fair in 3 cases and poor in 0 case. Through olecranon osteotomy approach, the articular surface of distal humerus could be fully exposed, and the operation is convenient. Anatomical reduction and rigid fixation of the articular surface of distal humerus are the key factors for the succesful outcome.

A PROSPECTIVE STUDY ON FUNCTIONAL OUTCOME OF DISTAL HUMERUS FRACTURE TREATED BY ORTHOGONAL PLATING

The distal humeral fractures, especially the comminuted intra articular, remain one of the most challenging injuries to treat. Various problems in distal humerus fracture management include frequent articular involvement, metaphyseal comminution, bone loss and osteopenia. The study analysed the functional outcome of twenty patients of distal humeral fractures treated surgically with orthogonal plating with average follow up of 13months (6 months – 2 ½ years). The good anatomical alignment, absolute stabilization and early mobilization were of prime importance in elbow fractures. Subjects of this prospective study were 20 consecutive patients based on the exclusion and inclusion criteria. All patients underwent ORIF with orthogonal plating through Olecranon osteotomy (Chevron) approach. The patients were followed up periodically based on the MEPS (Mayo Elbow Performance Score) and radiological outcome were analysed. The Mean age of the patients was 45 years ranging from 20 to 65 years.AO type C3 fractures constituted 50% while C2 fractures constituted 45%And C1 fractures constituted only 5% of our cases. In our study, the average surgical time delay was 6 days ranging from 5 to 20 days. Two patients had infection. None of them had ulnar nerve damage post operatively. Stiffness was noted in 2 patients. No patient died during treatment or follow up. The average time to union was about 14 weeks. There was no hardware failure or non-union in any patient. The mean exion-extension arc was 96°. The mean MEPS score was 78 in our study. Of the 20 patients, 9(45%) patients had Excellent, 5(25%) patients had good, 4(20%)patients had fair, 2(10%)patients had poor nal outcome. We conclude that with good anatomical reduction with a stable internal xation, preserving the blood supply to the bone along with protection of the ulnar nerve and early elbow mobilization ensure the good functional outcome and early return to activities

Results of Intra-Articular Distal Humerus Fracture Treated with Open Reduction and Internal Fixation

Introduction: Distal humerus fractures are uncommon injuries that account for fewer than 2% of all adult fractures. The complex shape of the elbow joint, the adjacent neurovascular structures, and the soft-tissue envelope combine to make these fractures difficult to treat. The treatment usually consists of determining the injury mechanism and developing a treatment algorithm to regain full mobility of the joint. Materials and Methods: This is a prospective study of 20 cases of distal humerus intra-articular fracture treated by open reduction and internal fixation at our institute during 2017–2019. All the patients in this study were above 18 years of age. These patients were treated with open reduction and internal fixation either by paratricipital approach for fractures with minimal intra-articular comminution or by olecranon osteotomy approach for fractures with more intra-articular comminution. Results: In this study of 20 patients with distal humerus fracture treated with open reduction and internal fixation with ages ranging from 18–65 years, 13 (65%) were male patients and 7 (35%) were female patients. 12 (60%) patients had fracture on the left side, and 8 (40%) patients had fracture on the right side. 11 (55%) patients sustained fractures following the fall from height, and 9 (45%) patients had fracture due to a road traffic accident. Postoperatively, 2 (10%) patients had superficial infection; both patients recovered with antibiotics. In our study, 17 (85%) patients had excellent results, and 3 (15%) patients had a good result according to the Mayo Elbow Performance Score. Conclusion: Distal humerus intra-articular fractures require anatomical reduction of intra-articular components. Vigorous, active physiotherapy is a must for good results. Rigid internal fixation is best accomplished by low-profile anatomical plate fixation, which provides an optimal biomechanical stability; hence, early mobilization can be started, and a good functional outcome can be achieved with a low complication rate.

Effectiveness of total elbow arthroplasty via olecranon osteotomy approach

To investigate the effectiveness of total elbow arthroplasty (TEA) via olecranon osteotomy approach. Between January 2011 and December 2021, 22 patients (25 sides) with elbow joint disease were treated with TEA via olecranon osteotomy approach. There were 9 males and 13 females with an average age of 52.0 years (range, 32-80 years). The disease involved unilateral elbow joint in 19 cases, including 12 cases on the left side and 7 cases on the right side, and 3 cases with bilateral elbow joints. There were 3 cases (3 sides) of osteoarthritis, 7 cases (9 sides) of rheumatoid arthritis, 6 cases (7 sides) of traumatic arthritis, 4 cases (4 sides) of distal humeral fracture, and 2 cases (2 sides) of elbow tuberculosis. The operation time, intraoperative blood loss, and postoperative complications were recorded. The Mayo Elbow Performance Score (MEPS) and range of motion (ROM) were used to evaluate the elbow joint function, and imaging was used to review the position of the prosthesis and the healing of the osteotomy. The operation time ranged from 53 to 120 minutes (mean, 90.6 minutes); intraoperative blood loss ranged from 10 to 200 mL (mean, 68.4 mL). All incisions healed by first intention. All patients were followed up 3.9-126.7 months, with a median time of 47.6 months. At last follow-up, the MEPS scores of 22 patients ranged from 72 to 100 (mean, 91.6); the elbow joint function was rated as excellent in 17 sides, good in 7 sides, and fair in 1 side, with an excellent and good rate of 96%. Elbow joint ROM was 98°-140° in flexion (mean, 119.7°), 5°-23° in extension (mean, 13.9°), 70°-90° in anterior rotation (mean, 83.3°), and 63°-90° in posterior rotation (mean, 79.4°). The follow-up time of 17 patients (20 sides) without fracture and joint stiffness before operation was 3.9-126.7 months, with a median time of 53.9 months; at last follow-up, the MEPS score and the elbow joint ROM were significantly better than those before operation ( P<0.05). The follow-up time of 5 patients (5 sides) with fracture and joint stiffness before operation was 12.0-124.2 months, with a median time of 40.1 months. At last follow-up, MEPS scores ranged from 89 to 100 (mean, 91.2), and elbow joint ROM restored. Two cases (2 sides) developed ulnar nerve symptoms after operation, and 1 case (1 side) suffered from periprosthetic fracture and periprosthetic infection after revision, and the elbow prosthesis was removed. The prosthesis survival rate was 96%. During follow-up, no prosthesis loosening occurred. The intraoperative visual field exposure of TEA via the olecranon osteotomy approach is sufficient, which can reduce the incidence of complications such as triceps weakness and ulnar nerve injury, effectively improve the function of the elbow joint, and obtain satisfactory effectiveness.

Lateral epicondyle osteotomy approach vs. olecranon osteotomy approach: an anatomic study of cadavers.

Exposure of the articular surface is the key to successful open reduction and internal fixation treatment for coronal shear fractures of the distal humerus. The olecranon osteotomy approach has previously been described as one of the most effective exposure approaches. Nevertheless, this approach cannot expose the anterior trochlea, and it is impossible to reduce and fix the capitellum under direct vision. The purpose of this study was to compare the exposure of the articular surface of the distal humerus between the lateral epicondyle osteotomy approach (group L) and the olecranon osteotomy approach (group O). Each approach was performed on 8 freshly frozen upper limbs of adult cadavers. After each approach was completed, a 0.5-mm Kirschner wire is inserted along the edge to mark the visible part of the articular surface. Then, the soft tissue of each elbow is removed, and a surface-scanning system is used to create a digital 3-dimensional model. The visible part of the articular surface obtained by each surgical approach was mapped and quantified using markers created by Kirschner wires. The lateral epicondyle osteotomy approach and the olecranon osteotomy approach exposed 0.8±0.0 and 0.6±0.0 of the distal humeral articular surface (P<.001), 1.0±0.0 and 0.3±0.1 of the capitellum (P<.001), 0.6±0.0 and 0.7±0.0 of the trochlea (P<.001), 0.7±0.0 and 0.5±0.1 of the anterior trochlea (P<.001), and 0.5±0.0 and 1.0±0.0 of the posterior trochlea, respectively (P<.001). Compared with the olecranon osteotomy approach, the lateral epicondyle osteotomy approach could more fully expose the total articular surface of the distal humerus, capitellum, and anterior trochlea, but the olecranon osteotomy approach could more fully expose the trochlea and posterior trochlea.

INTRA-ARTICULAR FRACTURES OF DISTAL HUMERUS MANAGED WITH ANATOMIC PRE-CONTOURED PLATES VIA OLECRANON OSTEOTOMY APPROACH

The treatment for displaced intra-articular fractures of the distal humerus is open reduction and internal fixation with early rehabilitation. Best exposure of both columns and articular surface of the distal humerus is achieved through olecranon osteotomy approach and fixation of two columns of distal humeruswith orthogonal plate construct which will allow absolute stability and early rehabilitation to restore early elbow joint function. 16 cases of intra-articular fractures of distal humerus were treated by open reduction and internal fixation (ORIF) with orthogonal plate construct via olecranon osteotomy approach. Chevron type olecranon osteotomy was performed and fixed with tension band wiring using 6mm CCS and SS wires in all cases. Radiological evaluationand regular clinical examination were done as per Mayo elbow Performance score. All fractures united within average duration of 3 months. More than 1000 range of motion is attained in 14 of cases. The mean Mayo Elbow Performance Score was 90.01 indicating excellent results. The factors for a successful outcome of intra-articular fractures of the distal humerus depends upon anatomic reduction, surgical technique, stable internal fixation, and early rehabilitation. ORIF with orthogonal plate construct securing both humeral columns via olecranon osteotomy approach results in excellent healing and functional outcomes.

Outcome of Fixation of Distal Humerus Fracture via Paratricipital Approach – A Prospective Study

Background: Fractures of the distal humerus continue to challenge surgeons due to their complex nature and the multiple options of fixation. The olecranon osteotomy approach is considered the gold standard, especially in those fractures with an intra-articular comminution, but is associated with complications. In selected cases, utilizing the triceps-on or paratricipital approach should allow adequate fixation while decreasing the incidence of complications. Methods: Patients with distal humerus fractures were treated with open reduction and internal fixation via the paratricipital approach. All patients were evaluated based on their preoperative and intraoperative parameters. Postoperative rehabilitation was implemented and the functional outcome was assessed based on the range of motion and Mayo Elbow Performance Score. Results: The current study encompassed thirty patients with a mean age of 47.5 years. AO/OTA C1 type fracture was encountered in 13 patients. The mean operative time was around 90 min. The mean elbow flexion at 2 months was 127.5°. Union was achieved in all patients, and one patient had surgical site infection. Conclusion: Metaphyseal and simple inter-articular fractures may be adequately visualized and managed with the above approach. Early rehabilitation allows faster return to normal function.

Functional outcome of distal humerus fracture in adults followed with bicolumnar fixation: A prospective study

Background: Distal humerus Fractures account for about 0.5 - 2% of all adult fractures, out of which a significant percentage (50 - 70%) of patients present with intraarticular and intercondylar involvement; thereby posing operative challenges to the surgeon. An attempt has been made in this study to evaluate the radiological and functional outcome of distal humerus fractures treated with bi columnar fixation. Materials and Methods: Our study consists of 20 posts traumatic distal humerus fracture AO type C operated at Rajah Muthiah Medical College and Hospital, Annamalai University, Chidambaram between May 2019 and December 2021. The Mayo Elbow Performance Score was employed for the assessment of Functional Outcome. Patients were regularly followed up at the intervals of 6 weeks, 3 months, 6months and 1 year postoperatively. Results: There were 13 (65.0%) female patients, and 7 (35%) male patients over a wide age range of 18 years to 75 years. The mean age of these patients being 44.6 years. The majority had an involvement of the nondominant limb; left humerus 15 (75%) and the rest of the cases were right humerus 5 (25%). The fractures were stabilized with bicolumnar locking compression plates with Lag Screws depending on the fracture pattern. The final follow-up majority showed good to excellent outcomes with the mean arc of elbow flexion of 116 degrees, average extension deficit of 7 degrees, average supination of 70 degrees, and average pronation of 70 degrees. Conclusions: Olecranon Osteotomy approach gave a better visualization of the fracture site and an easier articular reconstruction opportunity. Bicolumnar fixation showed good outcomes and achieved satisfactory union rates.

Comparison of TRAP (triceps reflecting anconeus pedicle approach) v/s olecranon osteotomy approach for treatment of intercondylar fracture humerus

Distal humerus fractures constitute 2 to 7% of all the elbow fractures. Young males are most commonly affected due to high energy trauma and secondly seen in elderly women due to osteoporosis. Due to complex anatomy and neurovascular network nearby, the treatment is very difficult. Anatomical reconstruction is the key for successful functional outcome. We compared the TRAP and olecranon osteotomy approach for the management of intraarticular fractures of the humerus in terms of functional, clinical and radiological outcome. The study was conducted in the Department of Orthopaedics &amp; Traumatology, MGM Medical College and MY Hospital, Indore from August 2019 to August 2021 on 30 patients with intra-articular fractures of humerus. 15 patients were treated with olecranon osteotomy and 15 patients were treated with TRAP approach, on patients fulfilling all the inclusion, but none of the exclusion criteria. The functional outcome was measured using Mayo Elbow Performance Score (MEPS) and radiographs were used for evaluating the bone union time.There was a male predominance. Assault, fall and road traffic accidents were the modes of injury. 13-B2, 13-C1 and 13-C3 were commonly seen fracture types. Mean MEPS was significantly better in TRAP (P&amp;#60;0.05) and full triceps strength was achieved in 86.7% patients by 3 months in TRAP and by 6 months in olecranon osteotomy group. The mean blood loss and duration of surgery was significantly longer in olecranon group (P&amp;#60;0.05). The bone union time and hospital stay were comparable between the groups (P&amp;#62;0.05). 73.3% patients of TRAP and 64.3% patients of olecranon osteotomy group achieved excellent outcome by 6 months.TRAP approach is comparatively better than osteotomy approach. Both the methods provide a stable fracture fixation, but complications are more in osteotomy in comparison to TRAP and we found TRAP to be functionally better.: TRAP-triceps reflecting anconeus pedicle approach, MEPS-Mayo Elbow Performance Score, DASH-disabilities of the arm, shoulder and hand, POP-plaster of Paris

Bilateral triceps tendon approach is flexible and efficient in the treatment of type C distal humerus fractures

PurposeThe purpose of this study was to assess and compare elbow range of motion, triceps extension strength and functional results of type C (AO/OTA) distal humerus fractures treated with bilateral triceps tendon (BTT) approach and olecranon osteotomy (OO). At the same time, we are also trying to know whether BTT approach can provide sufficient vision for comminuted intra-articular fractures of the distal humerus, and whether it is convenient to convert to the treatment to total elbow arthroplasty (TEA) or OO. MethodsPatients treated with OO and BTT approaches for type C distal humerus fractures between July 2014 and December 2017 were retrospectively reviewed. Inclusion criteria include: (1) patients' age were more than 18 years old, (2) follow-up was no less than 6 months, and (3) patients were diagnosed with type C fractures (based on the AO/OTA classification). Exclusion criteria include: (1) open fractures (Gustillo type 2 or type 3), (2) treated by other approaches, and (3) presented with combined injuries of ipsilateral upper extremities, such as ulnar nerve. Elbow range of motion and triceps extension strength testing were completely valuated, when the fractures had healed. Assessment of functional results using the Mayo elbow performance score and complications were conducted in final follow-up. The data were compared using the two tailed Student's t-test. All data were presented as mean ± standard deviation. ResultsEighty-six patients of type C distal humerus fractures, treated by OO and BTT approach were retrospectively reviewed between July 2014 and December 2017. Fifty-five distal humerus fractures (23 males and 32 females, mean age 52.7 years) treated by BTT approach or OO were included in this study. There were 10 fractures of type C1, 16 type C2 and 29 type C3 according to the AO/OTA classification. Patients were divided into two surgical approach groups chosen by the operators: BTT group (28 patients) and OO group (27 patients). And the mean follow-up time of all patients was 15.6 months (range, 6–36 months). Three cases in BTT group were converted to TEA, and one converted to OO. Only one case in BTT group presented poor articular reduction with a step more than 2 mm. There were not significantly different in functional outcomes according to the Mayo elbow performance score, operation time and extension flexion motion are values between BTT group and OO group (p > 0.05). Complications and reoperation rate were also similar in the two groups. Triceps manual muscle testing were no significant difference in the two groups, even subdivided in elder patients (aged >60 years old). ConclusionBTT is a safe approach to achieve similar functional result comparing with OO. BTT were not suitable for every case with severe comminuted pattern, but it avoids the potential complications related to OO, and has no complications concerning with triceps tendon. It is convenient for open reduction internal fixation and flexible to be converted to OO, as well as available to be converted to TEA in elder patients.

Triceps Tenotomy as an Alternative Exposure for Fixation of OTA/AO 13-C Fractures: A Technical Trick.

Intra-articular fractures of the distal humerus present challenges to treating physician and patient alike. The olecranon osteotomy is accepted as the standard exposure for intra-articular distal humerus fractures; nevertheless, complications such as nonunion and implant prominence are common. In this article, we describe the clinical outcomes and anatomic features of the triceps tenotomy as an alternative method of exposure for internal fixation of intra-articular distal humerus fractures. The olecranon osteotomy approach affords greater exposure of the distal humerus articular surface; however, there was no difference in quality of fracture reduction, progression to fracture union, posttraumatic arthrosis, or implant failure between approaches in our series. The osteotomy approach resulted in a greater need for reoperation (15% vs. 46%, respectively); largely as a result of olecranon implant-related complications. In summary, the triceps tenotomy offers an alternative exposure for intra-articular distal humerus fracture fixation with comparable clinical outcomes to the olecranon osteotomy technique.

Clinical and radiological results of three different techniques for fixation of the olecranon osteotomy in the surgical treatment of distal humerus fractures: A retrospective comparison of plate-screw, tension band and intramedullary nail.

The aim of this study was to compare clinical and radiological results of three different techniques (plate-screw, tension band, and intramedullary nail) in the fixation of olecranon osteotomy in patients with intercondylar fracture of the distal humerus surgically treated by the olecranon osteotomy approach. Between January 2010 and December 2018, the study was initiated with 52 patients who underwent an olecranon osteotomy approach for an AO Type C distal humerus fracture. Thirty-seven patients (19 male, 18 female) who had regular control data and a final control examination were included in the study. In osteotomy fixation, we used tension band (K wire cerclage + Screw cerclage) in 20 patients, plate-screw in eight patients, and intramedullary nail fixation in nine patients. The functional evaluation included a measurement of the range of joint motion (flexion, extension, supination, pronation); MAYO elbow performance score; disabilities of the arm, shoulder, and hand (DASH) score; and comparative grip strength measurement, and a subjective pain assessment was performed using the visual analogue scale. The mean duration of follow-up was 44 (12-84) months. The mean time to union was 14 (7-32) weeks in patients that achieved union. The mean DASH score was 22 (0-72.7), the meanMAYOelbow performance score was 84 (35-100), and the mean VAS score was 3 (1-7). The mean grip strength was 32 (8-64) kgw in the treated extremity and 37 (17-70) kgw in the intact extremity. No statistically significant difference was detected between olecranon osteotomy fixation methods (tension band, plate-screw osteosynthesis, and intramedullary nailing) in terms of union time, DASH score, MAYO scale score, VAS score, extension, supination, and pronation (P > 0.05). The average grip strength (kgw) was lower than that in the uninvolved extremity, and this ratio was statistically significant (P = 0.04). The results of this study have shown that successful and comparable radiological and functional outcomes can be obtained by all the three different olecranon osteotomy techniques in the surgical treatment of intercondylar fracture of the distal humerus. Level III, Therapeutic Study.

Comparison of Functional Outcomes in the Management of Intercondylar Fractures by Olecranon Osteotomy Approach versus Triceps on and Triceps off Approach

Intercondylar fracture of the distal humerus is a relatively rare and challenging intra-articular elbow fracture, with available choice of surgical treatment includes open reduction and extensive internal fixation. This systematic review aims to evaluate the effectiveness of the surgical approach regarding the functional outcome following intercondylar fracture treatment. A systematic search on literature was performed online from the inception dates to November 2020. Main outcome of interest included functional outcomes, Mayo Elbow Performance Score (MEPS) and The Disabilities of the Arm, Shoulder and Hand (DASH) Score. Animal studies, case reports, review articles and non-English papers were excluded. Four articles were included in this review. The functional outcome was different among the olecranon osteotomy approach, triceps on with the triceps sparing approach and triceps off with the triceps lifting approach or the TRAP approach. Triceps on approach with triceps sparing had lower MEPS in patients above 60 years of age but satisfactory in younger patients, while olecranon osteotomy approach showed excellent MEPS rate in all age groups. Olecranon osteotomy approach gives better exposure for more accurate anatomical reduction of the intra articular fracture resulting in better functional outcome. Mean DASH score was significantly higher in Triceps Reflecting anconeus (TRAP) group. Olecranon osteotomy approach was found to be better than triceps on approach, with better functional outcome. However, other triceps off (TRAP) did not show any significant differences in terms of functional outcome in the management of intercondylar fractures. Keywords: intercondylar fractures, olecranon osteotomy, triceps on, triceps off, functional outcome.

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

A Study comparing Olecranon osteotomy with Triceps reflecting anconeus pedicle approach (TRAP) for internal fixation of supracondylar and intercondylar fractures of the humerus

Objective: To evaluate the outcome of the Olecranon osteotomy approach and TRAP (triceps reflecting anconeus pedicle) approach and comparing them, attributable to Mayo Elbow Performance Score, range of motion, duration of fracture union and duration of surgery. Studydoneat: Government Medical College, Ratlam, MP, India Method and Material: The study is a retrospective randomized control trial on patients with intercondylar and supracondylar fractures of humerus admitted and operated in Department of Orthopaedics, Government medical college and District Hospital, Ratlam from July 2019 to September 2020. Total of 30 patients was included in the study, 15 in each group viz. Group-A operated by TRAP approach and Group-B operated by olecranon osteotomy approach. Results: The difference in Mean duration for fracture union was not statistically significant, in group-A was 12.21 ± 1.621 weeks, while it was 13.46 ± 2.307 weeks in group-B. Duration of surgery was statistically significantly different, more in group B (1.42 ± 0.14 hours) compare to group-A (1.21 ± 0.21 hours). Comparison between ranges of motion of both groups was assessed by Average of extension lag, the mean elbow arc of motion and average of flexion. No significant difference was found between the parameters. The average of extension lag was 11.96 ± 9.26 degree in group-A and it was 16.77 ± 10.31 degree in group-B. The mean elbow arc of motion in group A was 98.34 ± 24.17degrees and in group B was 91.25 ± 21.84 degrees. Average flexion was 109.71 ± 16.65 degrees and 111.47 ± 20.37degrees in group-A and group-B respectively. The average Mayo Elbow Performance Score in group-A was 86.93 ± 12.42 and in group-B was 83.48 ± 15.93. P-value was >.05 show that there was no statistically significant difference between two groups Mayo elbow score. Finally, 25 patients (83.33%) out of 30 showed good and excellent results and hence concluding that there is no statistically significant difference between these two modalities when it comes to outcome. Conclusion: TRAP approach is comparatively better than osteotomy approach in terms of stable fracture fixation and better outcome, with the advantage of intact olecranon. However the approach demands fast rehabilitation. Design: Prospective randomized control trial