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Objectives To compare elbow range of motion (ROM), triceps extension strength, and functional outcome of AO/OTA type A distal humerus fractures treated with a triceps-split or -sparing approach. Design Retrospective review. Setting Two level one trauma centres. Patients Sixty adult distal humerus fractures (AO/OTA 13A2, 13A3) presenting between 2008 and 2012 were reviewed. Exclusion criteria removed 18 total patients from analysis and three patients died before final follow-up. Intervention Patients were divided into two surgical approach groups chosen by the treating surgeon: triceps split (16 patients) or triceps sparing (23 patients). Main outcome measurements Elbow ROM and triceps extension strength testing were completed in patients after fractures had healed. All patients were also given the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Results Compared to the triceps-split cohort, the triceps-sparing cohort had greater elbow flexion (sparing 143 ± 7° compared to split 130 ± 12°, p = 0.03) and less extension contracture (sparing 6 ± 8° compared to split 23 ± 4°, p < 0.0001). Triceps strength compared to the uninjured arm also favoured the triceps-sparing cohort (sparing 88.9 ± 28.3% compared to split 49.4 ± 17.0%, p = 0.007). DASH scores were not statistically significant between the two cohorts (sparing 14.5 ± 12.2 compared to split 23.6 ± 22.3, p = 0.333). Conclusions A triceps-sparing approach for surgical treatment of extra-articular distal humerus fractures can result in better elbow ROM and triceps strength than a triceps-splitting approach. Both approaches, however, result in reliable union and similar functional outcome. Level of evidence Level III. [ABSTRACT FROM AUTHOR]

In Australia, a significant number of culturally and linguistically diverse (CALD) grandparents are sole carers for their grandchildren. Available information on the impact of caring on CALD grandparents and the ability of service providers to respond to their needs is limited. Our needs-gap analysis quality improvement project aimed to uncover 'hidden issues' for CALD grandparent carers so that services can be improved. One hundred service providers, such as community and aged-care services, child and/or grandparent support services and CALD-specific services, were approached using six structured questions. Six consultative forums on the caring role, issues encountered, and what needed to be done, were conducted with African, Asian, Spanish, Middle Eastern, European, Pacific Island andMaori grandparent carers in Queensland. The data were qualitatively analysed. Six themes emerged: 1) service provider and grandparent carer perception that there was limited research on CALD grandparents; 2) inadequate legal and financial support; 3) barriers to accessing information; 4) lack of childcare options; 5) transport difficulties; and 6) inadequate technological skills. Our findings provide insight to health service providers on the 'hidden issues' so that they can better assist CALD grandparent carers by improving access to relevant information, referrals and resources. [ABSTRACT FROM AUTHOR]