Triceps-sparing versus olecranon osteotomy for ORIF: Analysis of 67 cases of intercondylar fractures of the distal humerus
Introduction
Intercondylar fractures of the distal humerus (AO type C) constitute approximately 1% of all factures in adults.1, 2 These fractures are often difficult to treat and have an uncertain outcome. Restoration of satisfactory elbow function requires anatomic reconstruction of the articular surface and stable fixation of the fractured fragments to allow early and full rehabilitation.20 As a result, many favour open reduction and internal fixation (ORIF).11, 12 As in all forms of surgery, exposure and access to the structure are critical. Various techniques have been described for approaching the posterior distal humerus, and controversy exists regarding which approach is optimal in minimising complications and enhancing function.17 Olecranon osteotomy has been considered the gold standard, providing excellent exposure and avoiding problems such as disruption of the extensor mechanism, fibrosis and intramuscular nerve injuries.9, 14, 16 On the other hand, osteotomies can be complicated with delayed union, nonunion and prominent hardware.9, 14, 15, 16 In 1982, Bryan and Morrey described an alternative technique of approaching the posterior elbow, in which the triceps mechanism was spared and reflected from medial to lateral without detachment.3 This technique, which is used in total elbow arthroplasty, provides excellent exposure, preserves the triceps mechanism and confers good outcomes for complex intercondylar fractures.3 The purpose of the present study was to compare the triceps-sparing approach with olecranon osteotomy regarding their effects on the functional outcomes of intercondylar fractures of the distal humerus managed with ORIF, by reviewing 67 cases of intercondylar distal humerus fractures surgically managed with either of the approaches.
Section snippets
Patients
The medical records and radiographs of 67 patients with intercodylar (AO type C) distal humerus fractures treated with ORIF via the triceps-sparing approach or olecranon osteotomy by fellowship-trained senior orthopaedic surgeons at Xiangya Hospital (a first-class hospital in China) during 2001–2009 were reviewed. Of the 67 patients, there were 30 males and 37 females, with a mean age of 44.5 years (range, 16–77) and a mean follow-up time of 34.3 months (range, 6–89). According to the AO
Results
At the time of review, radiological evidence of fracture union was present in all patients, with a mean time of 12 weeks (range, 7–18). Patients with an excellent or good MEPS (n = 54) showed full weight bearing without tenderness. All patients with a fair MEPS (n = 11) showed mild pain and those with a poor MEPS (n = 2) showed moderate pain. As shown in Table 1, although there was no overall statistically significant difference in the average flexion, extension, arc of flexion/extension, pronation,
Discussion
The present study compared the triceps-sparing approach with olecranon osteotomy with regard to their effects on the functional outcomes of intercondylar fractures of the distal humerus managed with ORIF. By reviewing 67 cases of intercondylar distal humerus fractures surgically managed with either of the two approaches, we found that ORIF via the triceps-sparing approach would confer inferior functional outcomes for intercondylar distal humerus fractures in patients over the age of 60 years,
Conclusions
The results of this study lead us to preferentially treat intercondylar distal humerus fracture in patients over the age of 60 years with ORIF via olecranon osteotomy. Nevertheless, for patients less than the age of 60 years, especially those less than the age of 40 years, ORIF via either the triceps-sparing approach or olecranon osteotomy can confer comparable satisfactory outcomes.
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