Sinan Yilar, Muhammed Çağatay Engin, Murat Topal, Mehmet Kose, Gurkan Iden

A retrospective comparison of olecranon osteotomy and paratricipital approach in treatment of distal humerus intra-articular fractures

Aim: Paratricipital approach and Olecranon osteotomy are most commonly used to treat intra-articular distal humerus fractures in adults. In this study we have analysed the patients in whom we performed open reduction and internal fixation with and without olecranon osteotomy and evaluated the advantages and disadvantages of both methods. Materials and Methods: Between 2014 and 2018, 36 adult patients with intra-articular distal humerus fracture were retrospectively analysed. According to AO classification system 9, patient has Type B2, 1 Type B3, 7 Type C1, 10 Type C2 and 9 Type C3 fractures. Mayo Elbow Performance Score for evaluation of the elbow joint stability and Disabilities of Arm, Shoulder and Hand score to evaluate the functionality of shoulder, arm and hand was used. Results: Paratricipital approach was used in 12 patients (8 male , 4 female) and olecranon osteotomy in 24 patients. Mayo Elbow Performance Score and Disabilities of Arm, Shoulder and Hand scores were found respectively 15.808 and 81.25 in the Paratricipital group whereas those values were determined as 17.37 and 79.17, respectively. No statistically significant difference was found between two groups in terms of these two scorings (p=0.147 and p=0.244, respectively) A statistically significant difference was detected between the groups in terms of heterotopic ossification ( p=0.008). In the paratricipital group; no heterotopic ossification was found in 7 (58.3%) patients whereas Type 1 heterotopic ossification was detected in 5 (41.7%) patients. In the olecranon osteotomy group; no heterotopic ossification was found in 4 (16.7%) patients whereas Type 1 and Type 2 heterotopic ossification were detected in 16 (66.7%) and 4 (17.7%) patients, respectively (p=0.008). A statistically significantly higher rate of elbow degeneration and heterotopic ossification was observed in the patients who underwent osteotomy compared with those who were not performed osteotomy (p=0.008) Conclusions: Paratricipital approach can be performed as an alternative treatment option in the distal humerus fractures to reduce the postoperative complications even though it does not allow to perform a comprehensive preoperative evaluation of the joint as well as olecranon osteotomy approach.

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1. Begue T. Articular fractures of the distal humerus. Orthop Traumatol Surg Res 2014;100:55-63.
2. Bickel WE, Perry RE. Comminuted fractures of the distal humerus. Jama 1963;184:553-7.
3. Helfet DL, Schmeling GJ. Bicondylar intraarticular fractures of the distal humerus in adults. Clin Orthop Relat Res 1993;292:26-36.
4. Jung SW, Kang SH, Jeong M, Lim HS. Triangular Fixation Technique for Bicolumn Restoration in Treatment of Distal Humerus Intercondylar Fracture. Clin Orthop Surg 2016;8:9-18.
5. Miller AN, Beingessner DM. Intra-articular distal humerus fractures. Orthop Clin North Am 2013;44:35- 45.
6. Nauth A, McKee MD, Ristevski B, Hall J, Schemitsch EH. Distal humeral fractures in adults. J Bone Joint Surg Am 2011;93:686-700.
7. Cheung EV, Steinmann SP. Surgical approaches to the elbow. J Am Acad Orthop Surg 2009;17:325-33.
8. McKee MD, Wilson TL, Winston L, Schemitsch EH, Richards RR. Functional outcome following surgical treatment of intra-articular distal humeral fractures through a posterior approach. J Bone Joint Surg Am 2000;82:1701-7.
9. Pajarinen J, Björkenheim J-M. Operative treatment of type C intercondylar fractures of the distal humerus: results after a mean follow-up of 2 years in a series of 18 patients. J Shoulder Elbow Surg 2002;11:48-52.
10. Chen G, Liao Q, Luo W, et al. Triceps-sparing versus olecranon osteotomy for ORIF: analysis of 67 cases of intercondylar fractures of the distal humerus. Injury 2011;42:366-70.
11. 1Li SH, Li ZH, Cai ZD, et al. Bilateral plate fixation for type C distal humerus fractures: experience at a single institution. Int Orthop 2011;35:433-8.
12. Wilkinson JM, Stanley D. Posterior surgical approaches to the elbow: a comparative anatomic study. JJ Shoulder Elbow Surg 2001;10:380-2.
13. Pankaj A, Mallinath G, Malhotra R, Bhan S. Surgical management of intercondylar fractures of the humerus using triceps reflecting anconeus pedicle (TRAP) approach. Indian J Orthop 2007;41:219.
14. Hastings 2nd H, Graham TJ. The classification and treatment of heterotopic ossification about the elbow and forearm. Hand Clin 1994;10:417.
15. O'Driscoll SW, Sanchez-Sotelo J, Torchia ME. Management of the smashed distal humerus. Orthopedic Clin 2002;33:19-33.
16. Atalar AC, Demirhan M, Salduz A, et al. Functional results of the parallel-plate technique for complex distal humerus fractures. Acta Orthop Traumatol Turc 2009;43:21-7.
17. Sevimli R, Aslanturk O, Ergen E, Ertem K. Mid-term outcomes of arthroscopic treatment in patients with a stiff elbow. Cureus 2018;10.
18. O'Driscoll SW. The triceps-reflecting anconeus pedicle (TRAP) approach for distal humeral fractures and nonunions. Orthopedic Clinics 2000;31:91-101.
19. Dokmeci M, Kalender A, Sevimli R, Korkmaz M, Bilal O. The effect of ibandronate on fracture healing in rat tibia model. SM J Orthop 2016;2:1041.
20. Gupta R, Khanchandani P. Intercondylar fractures of the distal humerus in adults: a critical analysis of 55 cases. Injury 2002;33:511-5.
21. Ring D, Gulotta L, Chin K, Jupiter JB. Olecranon osteotomy for exposure of fractures and nonunions of the distal humerus. J Orthop Trauma 2004;18:446-9.
22. Sharma S, John R, Dhillon MS, Kishore K. Surgical approaches for open reduction and internal fixation of intra-articular distal humerus fractures in adults: a systematic review and meta-analysis. Injury 2018;49:1381-91.
23. Helfet DL, Hotchkiss RN. Internal fixation of the distal humerus: a biomechanical comparison of methods. J Orthop Trauma 1990;4:260-4.
24. Hong C, Nashi N, Hey H, et al. Clinically relevant heterotopic ossification after elbow fracture surgery: a risk factors study. Orthopaedics & Traumatology: Surgery & Research 2015;101:209-13.