Functional Outcomes after Triceps Splitting versus Triceps Sparing Approach for Extra-Articular Distal Humerus Fractures

Abstract

Aim: To compare the functional outcome as well as elbow range of motion (ROM) after triceps splitting and triceps sparing approach for AO/OTA TYPE A distal humerus fractures. Materials and Methods: This is a prospective study done at our center between 2011 and 2014. A total of 50 patients presented with extra articular distal humerus fracture (AO/OTA 13 A2, 13A3). Exclusion criteria removed 16 patients from the study while 2 patients died due to medical comorbidities before the final follow up. Out of the remaining 32 patients, they were divided into two groups: triceps splitting (15 patients) and triceps sparing (17 patients). Elbow ROM, along with Disabilities of the Arm, Shoulder and Hand questionnaire scores, was compared between the two groups. Results: Triceps sparing group had greater elbow flexion (140.0 ± 4.0) compared to triceps splitting group (126.0 ± 10.0) with p < 0.001. Extension contracture was also significantly less in triceps sparing (5.0 ± 6.0) group as compared to triceps splitting group (24.0 ± 8.0) with p < 0.001. However, there was no statistically significant difference in terms of DASH scores between the two groups with DASH score being (24.28 ± 10.14) in the sparing group as compared to (30.41 ± 14.36) in the splitting group with p = 0.169. Conclusion: As compared to triceps splitting approach, triceps sparing approach results in better elbow ROM with less extension contracture, however both approaches result in similar functional outcome.

Triceps Sparing Approach for Fixation of Distal Humerus Fractures in Adults

“…Jagdeep et al [3] reported that, the mean time of bone union was 11.8 ± 2.8 in triceps splitting, and 12.0 ±3.6 months in triceps sparing with non-significant difference. The mean elbow flexion was 140.0 ± 4.0 and 126.0±10.0 in triceps sparing and triceps splitting groups respectively, with significant difference.…”

“…Illica et al [11] reported that, the mean DASH score was [14.45 ± 12.17] in triceps sparing. Jagdeep et al [3] reported that, the mean DASH score was [24.28 ± 10.14] in triceps sparing.…”

“…However, surgical treatment provides more predictable alignment and a quicker return to function. These fractures can be managed by triceps splitting or sparing approaches [3] .…”

“…Triceps sparing technique escapes direct triceps trauma and performed with bloodless planes. This is the principal cause for improved elbow range of motion [ROM] and less postoperative contractures of the elbow [3] .…”