Evaluation of surgical treatment of inter-condylar humerus fracture with olecranon osteotomy approach

Abstract

Background: Inter-condylar fracture distal humerus in adults often pose a challenge to orthopaedic surgeons because of the complex anatomy, fracture pattern and limited bone stock of this region. Adequate exposure of the articular surface of the distal humerus and elbow joint is essential for operative stabilisation of complex distal humerus fracture. Various operative approaches have been recommended to access this difficult region which includes triceps splitting, triceps reflecting and trans-olecranon approaches though each approach has its own advantage & disadvantage. Olecranon osteotomy approach provides better visualization of complex intra-articular fractures, enabling accurate reduction and fixation. Aim of this study:To assess the functional outcome of intercondylar humerus fracture with olecranon osteotomy approach. Study design: prospective study Material and methods: Sixty patients of inter-condylar fracture humerus fulfilling the inclusion criteria were treated with internal fixation with various implants with olecranon osteotomy via posterior approach. Preoperative and postoperative radiograph measurements were taken and fractures were classified according to the AO system. All patients were operated through posterior trans-olecranon approach. Elbow exercises were started at third postoperative week. Patients were followed at three weeks and thereafter monthly, with clinical examination and x-rays. Results: The average ROM on follow up after 6 weeks was flexion up to 140 o and extension upto 5 o of elbow flexion. No cases of olecranon or distal humerus non-union were reported. Conclusions: Posterior surgical approach with olecranon osteotomy provides optimal exposure of the intra articular aspect of distal part of humerus and among them olecranon osteotomy gives the best exposure of the articular surface and there by better reduction and internal fixation which in turn gives better stability and good range of motion as compared to other approaches.

Triceps-off transfascial sleeve approach, functional outcomes and surgical technique in distal humerus fractures

“…Transolecranon osteotomy provides excellent exposure of the joint surface; however, osteotomy-related complications are high. 9,12,17,31 Gainor et al reported a 30% osteotomy nonunion rate in ten patients treated for distal humerus fractures with a transolecranon osteotomy, followed up at 24 months. 54 Comparative level 1 or 2 studies have not shown superior outcome with any of the approaches.…”

“…10 The olecranon osteotomy is the workhorse surgical approach to treat AO type C fractures as it provides excellent surgical exposure of the articular surface and unrestricted plating options. [10][11][12] There have been several documented concerns about the osteotomy, which include, from Goda et al, delayed union and non-union (10%), malunion and prominent hardware (25%); from Gofton et al, non-union (13%), heterotopic ossification (30%), infection (9%), reoperation rate (34%); from Kundel et al, non-union (12%), infection (8%), failure of fixation (4%), heterotopic ossification (49%); from Meldrum et al, non-union (3%), infection (3%), implant irritation (22%). [13][14][15][16] Somerson et al, in a recent paper, reported the olecranon osteotomy to be the only independent predictor for reoperation after fixation of intra-articular distal humerus fractures.…”