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

Abstract

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.