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Objective Olecranon osteotomy and paratricipital approaches were widely used in the treatment of type C distal humerus fracture but some disadvantages exist, so a combined medial and lateral approach was designed. The objective of this study was to investigate and compare the clinical outcomes of combined medial and lateral approach with the paratricipital approach in open reduction and internal fixation of type C distal humerus fractures. Methods From May 2018 to April 2020, 37 patients with type C distal humerus fracture who accepted open reduction and internal fixation in our hospital were enrolled in this study. All cases were randomly divided into two groups according to the surgical approach: combined medial and lateral approach group (19 cases), paratricipital approach group (18 cases). All of the patients received open reduction and double vertical plates fixation. The operation and follow‐up indexes, including operation time, blood loss, incision length, triceps muscle strength, flexion‐extension arc of elbow and forearm rotation arc, were recorded and compared. Caja score was used to assess the quality of fractures reduction. Mayo Elbow Performance Score (MEPS) was used to evaluate the elbow function in the follow‐up. Complications such as incision infection, ulnar nerve injury, degenerative osteoarthritis, and heterotopic ossification were analyzed. Results The differences in age, gender, and AO classification of fractures between two groups were not statistically significant (p > 0.05). The sum of medial and lateral incision length of combined approach group was longer than the midline incision of paratricipital approach group (15.4 ± 0.8 vs. 14.6 ± 0.8, p 0.05), blood loss (71.3 ± 24.5 vs. 72.8 ± 24.6, p > 0.05), and Caja score (16.05 ± 5.67 vs. 15.56 ± 5.66, p > 0.05). During the follow‐up, the MEPS of combined approach group was higher than that of paratricipital approach group at 3 months postoperatively (80.5 ± 5.7 vs. 68.9 ± 8.1, p 0.05) and at the last follow‐up (86.8 ± 7.1 vs. 86.9 ± 7.7, p > 0.05) between the two groups. There was no significant difference in triceps muscle strength (p > 0.05), flexion‐extension arc (126.8 ± 5.3 vs. 128.9 ± 6.0, p > 0.05), and forearm rotation arc (163.2 ± 5.3 vs. 163.6 ± 4.8, p > 0.05) at the last follow‐up. Although the incidence of complication of combined approach group (15.8%) was lower than that of paratricipital approach group (22.2%), the difference was not statistically significant (p > 0.05). Conclusions The combined medial and lateral approach was an effective and safe way of open reduction and internal fixation for type C distal humerus fractures. Compared with the paratricipital approach, the combined medial and lateral approach could restore the elbow function more quickly postoperatively, and the long‐term results were comparable.

In distal humerus fracture surgery, postoperative ulnar neuropathy is a common complication. The present study assessed the utility of the modified paratricipital approach for preventing ulnar neuropathy. This approach preserved the continuity of the attachment of the triceps with the ulnar nerve and allowed anterior subluxation of the ulnar nerve onto the hardware to be avoided. From December 2018 to March 2020, 13 patients who underwent surgery for distal humerus fracture through the modified paratricipital approach at our hospital were prospectively enrolled in the study. Ulnar neuropathy, Mayo Elbow Performance Score (MEPS), and Range of motion (ROM) were evaluated. No postoperative ulnar neuropathy was observed. At the final follow-up, the mean Mayo Elbow Performance score was 97.7 (range, 85–100). The mean arc motion was 132.7° (range, 115°–145°) with a mean flexion contracture of 4.2° (range, 0°–10°) and mean flexion of 136.2° (range, 120°–145°). Hardware breakage leading to a loss of reduction occurred in one case, but the other fractures united. Our results demonstrated the effectiveness of the modified paratricipital approach for preventing postoperative ulnar neuropathy. The modified paratricipital approach is a safe and reliable method of performing distal humerus fracture surgery. [ABSTRACT FROM AUTHOR]

Objective: Olecranon osteotomy and paratricipital approaches were widely used in the treatment of type C distal humerus fracture but some disadvantages exist, so a combined medial and lateral approach was designed. The objective of this study was to investigate and compare the clinical outcomes of combined medial and lateral approach with the paratricipital approach in open reduction and internal fixation of type C distal humerus fractures. Methods: From May 2018 to April 2020, 37 patients with type C distal humerus fracture who accepted open reduction and internal fixation in our hospital were enrolled in this study. All cases were randomly divided into two groups according to the surgical approach: combined medial and lateral approach group (19 cases), paratricipital approach group (18 cases). All of the patients received open reduction and double vertical plates fixation. The operation and follow‐up indexes, including operation time, blood loss, incision length, triceps muscle strength, flexion‐extension arc of elbow and forearm rotation arc, were recorded and compared. Caja score was used to assess the quality of fractures reduction. Mayo Elbow Performance Score (MEPS) was used to evaluate the elbow function in the follow‐up. Complications such as incision infection, ulnar nerve injury, degenerative osteoarthritis, and heterotopic ossification were analyzed. Results: The differences in age, gender, and AO classification of fractures between two groups were not statistically significant (p > 0.05). The sum of medial and lateral incision length of combined approach group was longer than the midline incision of paratricipital approach group (15.4 ± 0.8 vs. 14.6 ± 0.8, p < 0.05), but there was no significant difference in operation time (103.5 ± 10.2 vs. 106.0 ± 8.8, p > 0.05), blood loss (71.3 ± 24.5 vs. 72.8 ± 24.6, p > 0.05), and Caja score (16.05 ± 5.67 vs. 15.56 ± 5.66, p > 0.05). During the follow‐up, the MEPS of combined approach group was higher than that of paratricipital approach group at 3 months postoperatively (80.5 ± 5.7 vs. 68.9 ± 8.1, p < 0.05), but there was no significant difference in MEPS at 6 months postoperatively (83.9 ± 6.6 vs. 79.7 ± 7.0, p > 0.05) and at the last follow‐up (86.8 ± 7.1 vs. 86.9 ± 7.7, p > 0.05) between the two groups. There was no significant difference in triceps muscle strength (p > 0.05), flexion‐extension arc (126.8 ± 5.3 vs. 128.9 ± 6.0, p > 0.05), and forearm rotation arc (163.2 ± 5.3 vs. 163.6 ± 4.8, p > 0.05) at the last follow‐up. Although the incidence of complication of combined approach group (15.8%) was lower than that of paratricipital approach group (22.2%), the difference was not statistically significant (p > 0.05). Conclusions: The combined medial and lateral approach was an effective and safe way of open reduction and internal fixation for type C distal humerus fractures. Compared with the paratricipital approach, the combined medial and lateral approach could restore the elbow function more quickly postoperatively, and the long‐term results were comparable. [ABSTRACT FROM AUTHOR]

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.

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. [ABSTRACT FROM AUTHOR]

Objective: To report functional outcomes in a case series of distal shaft and distal humeral fractures (AO type 12 and 13) managed with open reduction and internal fixation using paratricipital approach. Methods: Patients who were intervened between May 2006 and December 2015 were included in the analysis. The Mayo Elbow Performance Score (MEPS), the Disabilities of the Arm, Shoulder and Hand (DASH) score and the visual analogue scale (VAS) were used for functional assessment. Results: Twelve patients were included in this case series, eight (67%) of them were women. The average age was 46 (SD 22). Regarding the type of fracture, three (25%) were classified as 12A1, two (17%) as 12B1, two (17%) as 12B2, three (25%) as 13C1 and two (17%) as 13C2. At most recent average follow-up of 3, 4 years (DS 1,62), the results were: elbow range of flexion–extension 138,3º (SD 15,18), MEPS reached 85,8 (DS 11,7), DASH of 11,8 (SD 10,6) and the mean VAS 1,3 (SD 1,1). At the final evaluation, all fractures had healed. One case presented radial nerve neuropraxia, three cases paresthesias at the ulnar nerve territory, and all of these evolved positively and spontaneously. Conclusions: In our experience, posterior paratricipital approach is useful and safe for managing the open reduction and internal fixation. It may provide preservation of the triceps and promote an earlier rehabilitation. Functional outcomes were satisfactory in this case series. [ABSTRACT FROM AUTHOR]

Objective The aim of this study is to evaluate the clinical, radiological and functional results of patients operated with a paratricipital approach in AO/OTA Type C1 and C2 distal humerus fractures. Materials and Methods 21 patients with AO/OTA type C1 and C2 intraarticular distal humerus fracture in our clinic between 2013-2018 who were operated with dual plates in two different planes using a triceps protective paratricipital approach were evaluated retrospectively. Range of motion measurement (ROM) and functional evaluation were performed with Mayo Elbow Performance Score (MEPS) in the last controls of the patients and elbow movements were recorded. Results Thirteen (61.9%) of the patients were male and 8 (38.1%) were female, and the mean age was 43.2 years. In 12 patients, double plate was applied at 90° angles, and in 9 patients, dual plate was used at 180° angles. All patients were operated with a triceps protective paratricipital approach. The patients were followed for an average of 18 months (12-23). Mean union time 13 week (9-18 week) and all fractures were unioned. In 81% of patients, the range of motion was 30° -130°, which is considered the functional range of motion. The average MEPS score was determined as 86.9 points, categorically; It was observed that 10 patients (47.6%) were very good, 7 patients (33.3%) were good, and 4 patients (19.1%) had moderate results. Conclusion Paratricipital approach which extensor mechanism protective is limited for visualized in fixation of AO/OTA type C1 and C2 intraarticular distal humerus fractures, but it provides sufficient exposure and satisfies functional results for the patient. [ABSTRACT FROM AUTHOR]

Background: Intercondylar humerus fractures (AO type 13C), though less common (less than 1%), are increasing over the last few years. Open reduction and internal fixation (ORIF) of these fractures are now well recognised and preferred management. These fractures are principally approached from posterior side and various posterior approaches have been mentioned. Triceps sparing is a relatively newer approach for fixation of these fractures. Here, we are ascertaining the outcomes of triceps sparing approach and olecranon osteotomy approach and also investigating the preferred approach in various age groups. Materials and methods: A level III non-randomized retrospective comparative study was conducted with a total of 60 patients belonging to AO type 13C2 in the age group of 16–70 years, operated upon during the period of September 2013 to March 2019. They were analysed for various outcome measures and complications. MEPS and DASH were used to determine outcome. Results: Out of a total of 60 patients (mean age 37.52 years), 28 were in olecranon osteotomy (OO) group and 32 were in the triceps sparing (TS) group. The mean operative time for group OO was 93.11 ± 8.78 minutes compared with group TS where it was 77 ± 4.64 minutes and the difference was statistically significant. Similarly, blood loss was 224 ± 46 ml in group OO compared with 197 ± 39 ml in group TS and it was also statistically significant. The average MEPS score was slightly better in the group TS (86.56 ± 10.66) compared with group OO (83.57 ± 10.96), though not statistically significant. Similarly, DASH score was 35.72 ± 8.35 in group TS and 35.32 ± 8.89 in group OO. The MEPS score was excellent (≥ 90) in 12 patients of group OO and 16 patients of group TS, good (75–89) in 11 patients of each group and fair (60–74) in 5 patients of each group. The patients in the age group of ≥ 60 years tend to have inferior functional outcomes, though not statistically significant, when treated with triceps sparing approach compared with olecranon osteotomy approach. Conclusion: In conclusion, we found that, compared with the olecranon osteotomy technique, better results though not statistically significant, can be expected with triceps sparing approach while treating type C2 distal humerus fractures in younger patients without significantly compromising the articular reduction or impairing stability of fracture fixation [ABSTRACT FROM AUTHOR]

Background: A number of surgical approaches have been described for open reduction and internal fixation (ORIF) of intra-articular distal humerus (IDH) fractures in adults. However, there is no consensus as to which approach is better in terms of functional outcomes and complications. The purpose of this study was to determine whether the functional outcomes and types and rates of complications are influenced by the choice of surgical approach for ORIF of IDH fractures (AO/OTA types 13 B & C).Methods: A systematic review of literature was performed using the PubMed, EMBASE and Cochrane Database of Systematic Reviews databases. Studies, both prospective and retrospective and comparative or non-comparative, dealing with surgical approaches for ORIF of IDH fractures in adult patients were included. Conference abstracts, studies looking primarily at the results of internal fixation rather than the surgical approach, those including extra-articular distal humeral fractures, pediatric distal humeral fractures (<18 years of age), delayed unions, non unions, malunions, cadaveric studies, pathological fractures and studies with <10 patients were excluded. Studies that looked at surgical modalities other than internal fixation (for e.g. total elbow arthroplasty) for intra-articular distal humerus fractures or those that did not report a validated functional outcome scoring system were also excluded.Results: 11 studies were included in the qualitative analysis, of which 5 were comparative studies and 6 were non-comparative. Quantitative analysis was performed on two sets of two studies, each set comparing the Bryan and Morrey or the triceps-split approach to the olecranon osteotomy approach, and revealed no significant differences in the Mayo Elbow Performance Score, range of motion and rates of complications. The overall methodological quality of the studies included in the review was low.Conclusions: High-quality evidence on surgical approaches for ORIF of IDH fractures in adults is lacking. Evidence from low-quality studies indicates that there is no difference in the functional outcomes or complication rates when comparing the Bryan and Morrey or triceps-split to the olecranon osteotomy approach. Future research in the form of high-quality randomized controlled trials is needed to determine which approach is superior in terms of functional outcomes and complications. [ABSTRACT FROM AUTHOR]

Background: Studies have reported favorable outcomes using the paratricipital approach for fixation of distal humeral intra-articular fractures. However, literature evaluating the clinical results of the approach remains limited. The objective of this study was to compare clinical outcomes between type 13C2 and type 13C1 distal humeral fractures after open reduction and internal fixation performed using the same approach and same type of plate., Methods: A total of 52 adults with type 13C1 or 13C2 distal humeral fractures were treated surgically at our institution during 2006 to 2018. We retrospectively analyzed data from 29 of these patients (19 with type 13C1 fractures and 10 with 13C2 fractures) who met the inclusion criteria. All subjects were followed for a minimum of 2 years postoperatively. Clinical and radiologic results were analyzed to determine differences in outcomes between the two types of fractures. Clinical results were evaluated using elbow range of motion (ROM), Mayo Elbow Performance Score (MEPS), and Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score. Alignment, fracture union, and presence of posttraumatic arthritis were evaluated radiologically., Results: The patients' mean age was 51 years, and the mean duration of follow-up was 29 months. Mean ROM was 129.5° ± 21.5° in the type 13C1 group and 123.0° ± 20.6° in the 13C2 group ( p = 0.20). Mean Q-DASH score was 12.6 ± 11.7 in the 13C1 group and 16.2 ± 19.8 in the 13C2 group ( p = 0.60). Mean MEPS was 92.9 ± 8.5 in the 13C1 group and 85.0 ± 14.1 in the 13C2 group ( p = 0.09). Carrying angle did not differ significantly between the 13C1 and 13C2 groups. No patient in either group exhibited nonunion or posttraumatic arthritis., Conclusions: Although the paratricipital approach has the disadvantage of limited visualization of articular surfaces, there were no differences in surgical outcomes between type 13C1 and type 13C2 distal humeral fractures after fixation using this approach. Thus, surgeons may need to consider using the paratricipital approach for open reduction and internal fixation of 13C2 distal humeral fractures., Competing Interests: CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported., (Copyright © 2022 by The Korean Orthopaedic Association.)

Purpose: To describe and evaluate the lateral para-olecranon approach for total elbow arthroplasty and to compare it with the paratricipital and triceps splitting approaches. Methods: A total of 34 patients who underwent total elbow arthroplasty were evaluated: 25 with rheumatoid arthritis (28 elbows) and 9 with fractures. The average duration of follow-up was 54 months (range, 12–105 mo). Of the 28 elbows with rheumatoid arthritis, 17 underwent a triceps splitting approach, 6 a lateral para-olecranon, and 5 a paratricipital approach. Of the 9 fracture cases, 5 patients underwent a lateral para-olecranon and 4 a paratricipital approach. Extension strength, range of motion, elbow function (Mayo Elbow Performance Index), and complications related to triceps insufficiency were compared for all 3 approaches. In addition, we compared triceps strength after lateral para-olecranon and paratricipital approaches with the contralateral healthy elbow in the 9 fracture cases. Results: Patients with rheumatoid arthritis had better extension torque when the prosthesis was implanted through the lateral para-olecranon approach (20 ± 8 N-m) compared with the triceps splitting (13 ± 4 N-m) or paratricipital approaches (12 ± 6 N-m). In the fracture group, the extension strength of the replaced elbow was similar to the contralateral normal elbow in both the paratricipital and lateral para-olecranon groups. Conclusions: The lateral para-olecranon approach avoids triceps tendon detachment from and repair to the olecranon, thereby reducing the risk of triceps insufficiency while maintaining better extension strength relative to a triceps splitting approach. Type of study/level of evidence: Therapeutic III. [Copyright &y& Elsevier]