Comparing approaches to expose type C fractures of the distal humerus for ORIF in elderly patients: six years clinical experience with both the triceps-sparing approach and olecranon osteotomy

Zhang, Chi; Zhong, Biao; Luo, Congfeng

doi:10.1007/s00402-014-1983-y

Cited by 57 publications

(56 citation statements)

References 22 publications

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“…Zhang et al . compared triceps sparing with olecranon osteotomy approach in 67 patients with type C distal humerus fracture in an elderly population and concluded that triceps-sparing group has better functional outcomes, faster patient recovery, and lower complication rate, all without compromising visibility of articular surface or impairing fracture reduction during fixation 23. In our study, the mean MEPI score was 94.40 point, with 17 excellent, five good, three fair, and no poor grade, which is consistent with other published series 3102225.…”

Section: Discussionmentioning

confidence: 99%

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

Yadav

Sharma

Gohiya

2016

IJOO

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Background:Displaced intraarticular distal humerus fracture has been conventionally treated operatively with various triceps disrupting approaches. These approaches are associated with several complications, such as triceps weakness, nonunion or delayed union of osteotomy, implant prominence, and delayed mobilization of the elbow. We present the functional outcome of intraarticular distal humerus fracture fixation using a triceps-sparing paratricipital approach which allows early elbow mobilization and preserving triceps strength.Materials and Methods:Twenty five patients with intraarticular distal humerus fracture were operated using triceps-sparing paratricipital approach with orthogonal plate construct. There were 16 male and 9 female patients and average age was 42.16 years (range 23-65 years). The mechanism of injury was fall from height (n = 8), road traffic accident (n = 13) and ground level fall (n = 4). Clinical, radiological, and functional assessment with Mayo Elbow Performance Index (MEPI) were obtained at follow up period.Results:All fractures united primarily. At the mean follow up of 13.58 months (range 6-22 months), mean elbow flexion was 121.08° (range 94°–142°) and mean motion arc was 114.92°(range 65°-140°). The mean MEPI score was 94.40 points (range 70–100) with 17 excellent, five good, and three fair results. The mean flexion deformity or extension loss was 6.16° (range 5°–15°).Conclusion:Open reduction and internal fixation of intraarticular distal humerus fractures with triceps-sparing paratricipital approach provide adequate exposure with no adverse effect on triceps muscle strength and allows early initiation of elbow motion. We analyzed, age and injury to surgical interval with relation to functional range of elbow using Z-test which is insignificant.

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Section: Discussionmentioning

confidence: 99%

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

Yadav

Sharma

Gohiya

2016

IJOO

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“…Reconstruction of osteotomy may cause delayed union, non-union, and bump of implant, which may compel further surgery. Correspondingly, triceps-splitting method does not produce adequate exposure of the articular surface compared with other methods; this method has one further drawback of direct muscle trauma, causing fibrosis and disruption to inter-muscular nerve branches, which can lead to muscle weakness [12]. Alonso-Llames first reported the paratricipital method in 1972 for pediatric supra-condylar fractures treatment [13].…”

Section: Discussionmentioning

confidence: 99%

“…This enabled us to reassure patients to execute a full range of elbow motions without any worries regarding non-union of the osteotomy or loosening of the implantation. Alleviation of these worries allow patients to execute triceps exercises shortly subsequent to the operation and consequently did not endure much triceps strength loss [12]. Additionally, active and passive ROM exercises may have supported the prevention of triceps weakness and elbow stiffness.…”

Section: Discussionmentioning

confidence: 99%

“…Compared with olecranon osteotomy, the triceps-sparing method generally produced a lower post-operative complication rate and shorter time needed for rehabilitation, while still upholding the advantages of a wide exposure [10,12,16]. However, Chen et al [4] showed an improved functional outcome for the olecranon osteotomy in 60-year-old patients and above.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes Following Alonso-Llames Triceps-Sparing Approach for Type-C Distal Humerus Fractures: A Single Center Study

Widodo¹,

Wira²,

Luthfi³

2019

JCR

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Introduction: The elbow joint is a combination of stability and motion of three individual articulations. Disruption resulting from distal humerus fractures will affect the functions and motions of the elbow joints significantly. Adequate restoration of elbow function compels reconstruction of the anatomical articular surface and steady fixation of the fractured fragments for early and complete rehabilitation. Any disruption of the triceps from the olecranon leads to weakened extension power. Triceps-sparing techniques may be able to maintain elbow strength by keeping the olecranon-triceps unit intact. Methods: A retrospective study was completed in Cipto Mangunkusumo Hospital, Jakarta comprising five cases of inter-condylar fracture of the humerus. The fractures types were AO type C1 and C2 fractures of the distal humerus. Exposure of supra-condylar ridges on the distal humerus were achieved by raising the medial and lateral flaps as in Alonso-Llames triceps-sparing approach. Double plating was used in all cases to stabilize the fractures fragment. Results: All five fractures had achieved union at the fourth month of followup. None of the patients endured loss of supination or pronation though all patients had several degree of flexion/extension reductions compared with the normal side. The mean Mayo Elbow Performance Index (MEPI) was 94 (range 85 to 100) representing superb outcome in twelve months follow up. Conclusion: The usage of triceps-sparing method to uncover type C distal humerus fractures led to decreased post-operative complication rate and quicker patient recovery without reducing the view of the articular surface or disturbing fracture reduction during fixation.

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“…Usually, surgeons can determine the trajectory of the locking screws in a distal humerus fracture treatment 11,12 , offering the surgeon a means to maximize xation in the distal fragments and providing the best possible outcome for the patient. However, the biomechanical properties of this plate xation system remain unknown.…”

Section: Cadaveric Bonementioning

confidence: 99%

Mechanical Strength of the Mayo Clinic Congruent Elbow Plate System for Distal Humerus Fractures: Cadaveric and Model Bone Model

Maruyama

Tomita

Kawasaki

et al. 2014

Showa Univ J Med Sci

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: The purpose of this study was to compare the Mayo Clinic Congruent Elbow Plate System with a plate system having the same biomechanical features as a conventional non-locking system. For testing, we used a biaxial adjustable material testing machine Mini-Bionix , MTS, Minnetonka, MN . A compressive load of 500 N / min was applied in the axial direction, and a torque of 30 deg / min was applied in the rotational direction to simulate internal rotation of the elbow. The relationships between force N and displacement mm , and between the internal rotational angle deg and torque N / m , were measured. The Mayo Clinic Congruent Elbow Plate and the two types of screws used in this study may provide suf cient xation strength. The results obtained here warrant further studies that are more dynamic e.g., cyclic loading and repetitive torsion tests , with a larger number of specimens, and that facilitate appropriate nomal elbow movement in daily living, to assess the utility of plate xation with locking and non-locking systems for distal humerus fractures.

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Comparing approaches to expose type C fractures of the distal humerus for ORIF in elderly patients: six years clinical experience with both the triceps-sparing approach and olecranon osteotomy

Abstract: Level III.

Cited by 57 publications

References 22 publications

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

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

Outcomes Following Alonso-Llames Triceps-Sparing Approach for Type-C Distal Humerus Fractures: A Single Center Study

Mechanical Strength of the Mayo Clinic Congruent Elbow Plate System for Distal Humerus Fractures: Cadaveric and Model Bone Model

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