Combined Medial and Lateral Approach Versus Paratricipital Approach in Open Reduction and Internal Fixation for Type C Distal Humerus Fracture: A Randomized Controlled Study

Abstract

ObjectiveOlecranon 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.MethodsFrom 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.ResultsThe 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).ConclusionsThe 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.

Shoulder and Elbow Surgery Special Issue

“…This issue features 32 professional articles, including three review articles, 21 clinical articles, four research articles, two operative techniques, and two case reports, contributed by well-known orthopaedic experts from China, the United States, Korea, and Europe.The elbow section of this issue includes papers on arthroscopy, 1 open surgery in elbow stiffness, 2,3 fractures, 4 total elbow arthroplasty, 5 and conservative methods of treatment. 6 The shoulder section addresses a multitude of anatomic details as well as techniques, including clavicular shaft and distal fractures, acromioclavicular joint traumatic and degenerative conditions, [7][8][9][10][11] rotator cuff pathologies and fixation techniques, treatment of the post-surgical or post-traumatic glenohumeral stiffness, fractures of the proximal humerus, 5,[12][13][14][15][16][17][18][19][20][21] the safety of irrigation in the shoulder arthroscopy, management of the scapular and glenoid fractures, radiologic and 3D models. [22][23][24][25][26][27][28][29][30][31] Overall, this special issue contains plenty of meaningful readings for surgeons specializing in shoulder and elbow surgery and for general orthopaedic and trauma specialists, as well as for orthopaedic residents and young surgeons worldwide.…”

“…The elbow section of this issue includes papers on arthroscopy , 1 open surgery in elbow stiffness 2 , 3 fractures , 4 total elbow arthroplasty , 5 and conservative methods of treatment. 6 The shoulder section addresses a multitude of anatomic details as well as techniques, including clavicular shaft and distal fractures, acromioclavicular joint traumatic and degenerative conditions, 7 , 8 , 9 , 10 , 11 rotator cuff pathologies and fixation techniques, treatment of the post‐surgical or post‐traumatic glenohumeral stiffness, fractures of the proximal humerus, 5 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 the safety of irrigation in the shoulder arthroscopy, management of the scapular and glenoid fractures, radiologic and 3D models. 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 …”