Olecranon osteotomy vs. triceps-sparing for open reduction and internal fixation in treatment of distal humerus intercondylar fracture: a systematic review and meta-analysis

Abstract

Background The open reduction and internal fixation (ORIF) was a standard treatment approach for fracture at distal humerus intercondylar, whereas the optimal way before ORIF remains inconclusive. We, therefore, performed a systematic review and meta-analysis to assess the efficacy and safety of olecranon osteotomy vs . triceps-sparing approach for patients with distal humerus intercondylar fracture. Methods The electronic searches were systematically performed in PubMed, EmBase, Cochrane library, and Chinese National Knowledge Infrastructure from initial inception till December 2019. The primary endpoint was the incidence of excellent/good elbow function, and the secondary endpoints included Mayo elbow performance score, duration of operation, blood loss, and complications. Results Nine studies involving a total of 637 patients were selected for meta-analysis. There were no significant differences between olecranon osteotomy and triceps-sparing approach for the incidence of excellent/good elbow function (odds ratio [OR]: 1.37; 95% confidence interval [CI]: 0.69–2.75; P = 0.371), Mayo elbow performance score (weight mean difference [WMD]: 0.17; 95% CI: −2.56 to 2.89; P = 0.904), duration of operation (WMD: 4.04; 95% CI: −28.60 to 36.69; P = 0.808), blood loss (WMD: 33.61; 95% CI: −18.35 to 85.58; P = 0.205), and complications (OR: 1.93; 95% CI: 0.49–7.60; P = 0.349). Sensitivity analyses found olecranon osteotomy might be associated with higher incidence of excellent/good elbow function, longer duration of operation, greater blood loss, and higher incidence of complications as compared with triceps-sparing approach. Conclusions This study found olecranon osteotomy did not yield additional benefit on the incidence of excellent/good elbow function, while the duration of operation, blood loss, and complications in patients treated with olecranon osteotomy might be inferior than triceps-sparing approach.

Triceps Sparing Approach for Fixation of Distal Humerus Fractures in Adults

“…Radiological outcome revealed that, union achieved in all patients. The mean time of bone union was 14.8 ± 0.72 weeks [12][13][14][15][16][17][18][19][20]. There were no non-union.…”

“…In the current study, ORIF was applied for 33 patients with distal humerus fractures through triceps-sparing approach. The mean elbow flexion was 140.45±3.82 degrees [135-145], and the mean elbow extension was 9.96±2.98 degrees [6][7][8][9][10][11][12][13][14][15]. Radiological outcome was achieved in all patients.…”

“…A meta-analysis by Lu S, et al [14] concluded that, triceps-sparing approach is superior to olecranon osteotomy, regarding the operative duration, blood loss, and complications. Both techniques were comparable regarding excellent/elbow function.…”

Comparison of olecranon osteotomy and paratricipital approach in distal humerus intra-articular fracture: A systematic review and meta-analysis

“…[8] The application of this approach in the treatment of distal humerus fractures has been reported in several studies, [9][10][11] including systematic reviews that have compared triceps-sparing approach with OO. [12] The paratricipital approach (PT), introduced by Alonso-Llames in 1972 [13] for the treatment of supracondylar fractures in children and modified by Schildhauser et al [14] for exposure of the articular surface of the distal humerus, has been investigated relatively recently. This approach offers the advantage of sparing the insertion of the triceps, which results in preservation of the extensor mechanism, when compared with other approaches.…”

“…[8] The application of this approach in the treatment of distal humerus fractures has been reported in several studies, [9–11] including systematic reviews that have compared triceps-sparing approach with OO. [12]…”