Functional outcome of intraarticular distal humerus fracture fixation using triceps-sparing paratricipital approach

Yadav, Vishal; Sharma, Pulak; Gohiya, Ashish

doi:10.4103/0019-5413.193487

Cited by 11 publications

(17 citation statements)

References 26 publications

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“…All surgeries were performed in the supine position under general anesthesia using a tourniquet. Each approach was performed using standard methods [ 14 , 15 , 16 , 17 ]. In the posterior approach, the ulnar nerve was first identified and protected.…”

Section: Methodsmentioning

confidence: 99%

Risk Factors for Non-Union after Open Reduction and Internal Fixation in Patients with Distal Humerus Fractures

Baek

Kim

2022

JCM

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Background: Only a few studies have reported on the risk factors for non-union after open reduction and internal fixation (ORIF) in distal humerus fractures. Methods: We retrospectively reviewed 155 patients who underwent ORIF for distal humerus fractures from January 2008 to June 2020. Various patient factors, including body mass index (BMI), diabetes mellitus (DM), and combined fracture, as well as surgical factors, including fixation methods (e.g., orthogonal plate/parallel plate/single plate/tension bend wiring [TBW]) and combined fracture operations, were evaluated as risk factors for non-unions. Results: Among the patient factors, BMI (25.0 ± 3.4 vs. 22.7 ± 3.4, p = 0.032), DM (5/13 [38.5%] vs. 20/142 [14.1%], p = 0.038) and combined fracture (5/13 [38.5%] vs. 16/142 [11.3%], p = 0.018) were significantly different between groups with non-union and union. Among the surgical factors, combined fracture operation (5 [38.5%] vs. 9 [6.3%], p = 0.002) and the fixation method (3 [23.1%]/1 [7.7%]/4 [30.8%]/5 [38.5%] vs. 84 [59.2%]/7 [4.9%]/40 [28.2%]/11 [7.7%], p = 0.005) showed a significant difference between groups with non-union and union. Multivariate regression analysis showed that combined fracture operation (OR 10.467; 95% CI 1.880–58.257; p = 0.007) and TBW (OR 9.176; 95% CI 1.474–57.135; p = 0.018) among the fixation methods posed as a significant risk factor for non-union. Conclusions: The risk of non-union increased in patients who underwent surgery for another fracture combined with distal humerus fracture and in patients who underwent ORIF with TBW.

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Section: Methodsmentioning

confidence: 99%

Risk Factors for Non-Union after Open Reduction and Internal Fixation in Patients with Distal Humerus Fractures

Baek

Kim

2022

JCM

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“…This study was conducted for supracondylar humerus fracture in adults treated by open reduction and internal fixation by parallel plates by olecranon osteotomy technique and they were followed up clinically and radiologically for 6 months. Yadav et al (19) reported that, the olecranon osteotomy approach does not seem to have a clinical advantage over the approaches that preserve the integrity of the elbow extensor device. However, a systematic review and meta-analysis conducted by Chen et al (20) compared various surgical approaches on elbow functional outcomes for patients with distal humerus intercondylar fractures (DHF).…”

Section: Discussionmentioning

confidence: 99%

Treatment of Supracondylar Humerus Fracture in Adults by Parallel Plates

Khater

El-Shoura

Hassan

2023

SJMS

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Objective: The aim of this study was to evaluate the outcome of parallel plates for the treatment of supracondylar humerus fractures in adults. Patients and Methods: This study included 20 adult patients with supracondylar humerus fractures. They were treated by open reduction and internal fixation by parallel plates through olecranon osteotomy technique. They were followed up clinically and radiologically for 6 months. On admission, all were assessed by careful history taking and detailed clinical examination. The preoperative radiological workup was performed by antero-posterior and lateral radiographs of the elbow with traction and computed tomography was performed with three-dimensional reconstruction. Postoperative, patients were assessed after 2, 4, 8, 12 weeks and 6 months of surgery, with clinical and radiological evaluations and assessed for pain, swelling, range of joint motion and radiological union. The functional assessment of the patient was done according to Mayo elbow performance index and the outcome was graded into excellent, good, poor and fair. RESULTS: The excellent outcome was achieved among 55.0%, while 30.0% had good, 10% had fair and 5.0% had poor outcome. The overall complication rate was 30.0% and the commonest were pain and stiffness (15.0% for each). The mean±SD times to clinical and radiological union were 12.75 ± 6.44 and 14.70 ± 7.84 weeks, respectively. The excellent outcome was significantly associated with lower rate of complications and shorter time to clinical and radiological union. CONCLUSION: Parallel plates for the treatment of adult supracondylar humerus fractures could be considered safe and effective technique, leading to good functional outcome and a complication rate comparable to published literature.

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“…The patient was put in a prone position on the examination table with the arm in 90° abduction, the elbow in 90° flexion, and the forearm in neutral rotation. With one hand of the surgeon supporting the patient's arm just above the elbow and the other hand applying resistance on the dorsal surface of the patient's forearm, the patient was asked to extend the elbow against resistance 16 …”

Section: Methodsmentioning

confidence: 99%

“…Therefore, the surgical approach that preserves the integrity of the elbow extensor device has been developed. Some scholars believe that a paratricipital approach was sufficient to meet the requirements of the surgical field without an olecranon osteotomy for type C distal humerus fractures 16,17 . The paratricipital approach was particularly suitable for extra‐articular and intra‐articular distal humerus fractures which were not complicated (C1 and C2 fractures) since it could preserve triceps continuity and the attachment to olecranon.…”

Section: Introductionmentioning

confidence: 99%

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

Teng

Zhong

et al. 2023

Orthopaedic Surgery

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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.

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Functional outcome of intraarticular distal humerus fracture fixation using triceps-sparing paratricipital approach

Cited by 11 publications

References 26 publications

Risk Factors for Non-Union after Open Reduction and Internal Fixation in Patients with Distal Humerus Fractures

Risk Factors for Non-Union after Open Reduction and Internal Fixation in Patients with Distal Humerus Fractures

Treatment of Supracondylar Humerus Fracture in Adults by Parallel Plates

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

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