Treating AO Type C2-3 Distal Humerus Fractures With the Anconeus Flap Transolecranon Approach

Abstract

We evaluated the outcomes of precontoured locking plate fixation with the anconeus flap transolecranon (AFT) approach to treating AO type C2-3 comminuted intra-articular distal humerus (IDH) fractures among active patients. Thirty-six patients (age <65 years) with IDH fractures treated with precontoured distal humerus locking plate fixation were divided into 2 groups: group 1 (n=18; transolecranon [TO] approach) and group 2 (n=18; AFT approach). The radiographic examination included assessments of implant failure, fracture site union, and olecranon osteotomy site union. Clinical examination included assessments of operating time, range of motion (ROM), Mayo Elbow Performance Score (MEPS), Disability of the Arm, Shoulder and Hand (DASH) score, and complications. The mean follow-up time was 25.2 months (range, 18–79 months). The mean operating time was 134.3 minutes and was significantly longer for group 2 (AFT; 141.2 minutes) than for group 1 (TO; 124.2 minutes). The mean olecranon osteotomy site union time was significantly longer in group 2 (7.4 weeks) than in group 2 (4.0 weeks). Olecranon osteotomy site resorption occurred among 6 of 18 patients only in group 2. No significant difference in ROM (flexion, 130°; extension, −0.7°), MEPS (85.7 points), DASH score (20.0 points), or frequency of major complications (TO, 5; AFT, 6) was observed between the groups. Our results showed no advantage of the AFT approach over the TO approach, despite preserving the anconeus. Prospective randomized trials will be necessary to compare the AFT and TO approaches for treating comminuted IDH fractures. [ Orthopedics . 2022;45(6):e326–e334.]

Surgical flip-dislocation of the bicolumnar approach without olecranon osteotomy versus olecranon osteotomy in type AO 13C3 distal humeral fracture: a matched-cohort study

“…OO is the most commonly used method for treating distal humeral fractures because it provides wide exposure to joint surfaces. However, several osteotomy-related complications can occur with reconstructing the olecranon, such as osteotomy healing issues (delayed union and nonunion), hardware failure (prominence of the screws or plates), irritation, infection, elbow joint stiffness, and heterotopic ossification, which may require additional surgery (Table 3 ) [ 12 , 13 , 21 – 25 ]. Similarly, the triceps-splitting approach does not adequately expose the articular surface compared to other procedures, as demonstrated in the above-mentioned cadaveric study [ 20 ], and this approach is accompanied by complications, such as fibrosis, intermuscular nerve branch injury, and muscle weakness caused by direct muscle trauma.…”