Triceps-sparing extra-articular step-cut olecranon osteotomy for distal humeral fractures: an anatomic study

Zumstein, Matthias A.; Raniga, Sumit; Flueckiger, Remy; Campana, Lorenzo; Moor, Beat K.

doi:10.1016/j.jse.2017.03.008

Cited by 10 publications

(6 citation statements)

References 31 publications

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“…In previous studies, 7,8 the corresponding area was determined by obtaining the mesh count of a net applied to the articular surface or by using a 3-dimensional scanner. 14 The results of the measurement in this study for the BT and OO procedures were consistent with those reported by Wilkinson and Stanley 8 and Dakour e et al, 7 who used mesh nets. Thus, our projection technique is considered a relatively simple and appropriate method of measurement.…”

Section: Discussionsupporting

confidence: 91%

“…The visible area by the BT and OO approaches has already been quantified in cadaver studies, but the surgical area exposed by the LPO approach has not been evaluated to date. 7,8,14 The purpose of this study was to quantify the visible area of the articular surface of the distal humerus exposed by the LPO approach and to compare this with the BT and OO approaches.…”

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confidence: 99%

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Comparison of the Visible Articular Surface between the Lateral Para-Olecranon Approach and Two Other Common Posterior Approaches for Distal Humeral Fracture: an Anatomical Study

Amemiya

Iwamoto

Suzuki

et al. 2019

Journal of Hand Surgery Global Online

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To quantify the visible area of the articular surface of the distal humerus exposed by the lateral para-olecranon (LPO) approach and to compare this with the bilaterotricipital (BT) and olecranon osteotomy (OO) approaches. Methods: We examined 12 elbows from 6 fresh cadavers (mean age, 93.5 years; range, 90e99 years; 3 men and 3 women). Elbows on one side of the cadavers underwent the LPO approach. The opposite elbows underwent the BT approach followed by the OO approach. Macroscopically observable articular cartilage was coated with synthetic silicone resin paint under direct vision. The dissected bone was fixed on the table and photographs of the distal humerus were taken from anteriorly and posteriorly. The color-coded areas projected on 2 planes were quantified using digital photography and computer analysis software. Results: Proportions of the total visible area, summation of the anterior and posterior visible articular areas, were 25.3% ± 2.2% for the BT procedure, 46.4% ± 8.4% for the LPO procedure, and 58.5% ± 5.7% for the OO procedure, showing significant differences among the 3 procedures. The LPO procedure achieves better exposure of the posterior articular surface than the BT procedure, but the LPO procedure had limitations in the anterior visible area compared with the OO procedure. In particular, direct vision of the humeral trochlea was restricted by the presence of the olecranon. Conclusions: The LPO approach has improved visualization of the distal humeral articular surface compared with the BT approach but not as good as that achieved with the OO approach. Clinical relevance: The LPO approach is applicable to cases of AO type C1 and C2 distal humeral fractures and some cases of type C3 fracture, excluding those accompanied by complex fractures in the trochlea of the humerus. It is important to evaluate the fracture line of the humeral trochlea in preoperative computed tomography to determine whether to use the LPO or OO approach for AO type C3 fracture.

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Section: Discussionsupporting

confidence: 91%

mentioning

confidence: 99%

Comparison of the Visible Articular Surface between the Lateral Para-Olecranon Approach and Two Other Common Posterior Approaches for Distal Humeral Fracture: an Anatomical Study

Amemiya

Iwamoto

Suzuki

et al. 2019

Journal of Hand Surgery Global Online

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“…The rst study found the SCOOT with tension band wiring technique provided improved stability compared to chevron and oblique osteotomy (3). A second study found the SCOOT to have a substantially increased (2.6-times) bone contact surface in the area of the osteotomy in comparison to the chevron osteotomy (22). The results of this study suggest that a simple osteosynthesis with two compression screws is su cient for osteosynthesis of the SCOOT.…”

Section: Discussionmentioning

confidence: 77%

A biomechanical study comparing the mean load to failure of two different osteosynthesis techniques for the Step-Cut Olecranon Osteotomy

Hess

Bürki

Moor

et al. 2020

Preprint

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Background: A tension band wiring technique is the current gold standard for osteosynthesis of olecranon osteotomies, although the technique has several practical disadvantages and its theoretical advantages have been questioned. The Step-Cut Olecranon osteotomy is an interesting new option for surgeons to access distal intra-articular humerus fractures, but its stability has only been assessed using the tension band wiring osteosynthesis. Therefore, the mean load to failure of this osteotomy with two different osteosynthesis techniques (tension band wiring and compression screws) was assessed. A higher load to failure was hypnotized for the tension-band-wiring osteosynthesis group. Methods: A Step-Cut Olecranon osteotomy was performed on 32 Sawbones. Half were secured by a tension band wiring and the other half by two compression screws. The humero-ulnar joint was simulated using an established test setup, which allows the application of triceps traction force through a tendon model to the ulna model, while the joint is in a fixed position. Eight models of each group were tested at one of two angles (20° and 70° of flexion) by isometrical loading until failure. A failure was defined as either complete fracture or gap formation of more than 2mm between osteotomy and the remaining model. Results: At 20° of flexion, the mean load to failure in the tension band wiring group was 1360 N (SD 238) and 1401 N (SD 261) in the compression screw group. At 70° of flexion, it was 1398 N (SD 215) and 1614 N (SD 427), respectively. Differences did not reach significance (p = 0.88 at 20°, p = 0.28 at 70°).Conclusions: A tension band wiring osteosynthesis does not provide higher stability than a compression screw osteosynthesis for the Step-Cut Olecranon osteotomy. A Step-Cut Olecranon osteotomy with screw osteosynthesis might be an interesting option for surgeons when treating intra-articular distal humeral fractures.

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“…Th e posterior approach to the elbow was practiced. Th e "V" osteotomy of the olecranon was practiced to retract brachial triceps and have a good articular and distal humerus exposure 12 . After fracture reduction and restoration of articular surfaces, osteosynthesis was performed with 2 fi xed angular locking plates respecting the 2 humeral columns, and the defect was fi lled with a bone substitute, artifi cial bone graft.…”

Section: Discussionmentioning

confidence: 99%

Proximal and Distal Humerus Fractures in a Patient with Chronic Inflammatory Joint Disease Undergoing Biologic Therapy

Turcu¹,

Moga²,

Dinache³

et al. 2018

Rev. Med. Mod.

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Bone changes occurring in people with rheumatoid arthritis increase the incidence of fractures in these patients. In the complex fractures of the 3-part proximal humerus, the treatment of choice is represented by open reduction and osteosynthesis. Because of the important role of the distal portion of the humerus in the elbow joint, fi rm osteosynthesis with angularly blocked implants provides a superior biomechanics and stability in the treatment of complex fractures even in the elderly with a diminished bone stock due to osteoporosis. The preliminary diagnosis was established following simple radiographs. Establishing the diagnosis required computerized tomography and three-dimensional elbow reconstruction. Surgery was performed following the analysis of the imaging data, practicing the fi rst step of reduction and osteosynthesis by the MIPO technique of the proximal humerus fracture, subsequent reduction and osteosynthesis of the distal humerus fracture, the defective bone was fi lled with artifi cial bone graft, and the osteosynthesis of the osteotomized olecan. Reduced soft tissue damage, reduced postoperative pain, reduced functional impairment, and axillary nerve protection confer superiority to osteosynthesis through the mini-invasive approach (MIPO) versus the transdeltoid approach. RezumatModifi cările ososase ce apar la persoanele cu poliartrită reumatoidă cresc incidenţa fracturilor la acești pacienţi. În fracturile complexe ale humerusului proximal cu 3 fragmente, tratamentul de elecţie este reprezentat de reducerea deschisă și osteosinteză. Datorită rolului important al porţiunii distale a humerusului, în cadrul articulaţiei cotului, osteosinteza fermă prin plăci blocate premulate, angular stabile, oferă o biomecanică și o stabilitate superioară în tratamentul fracturilor complexe chiar și la persoanele în vârstă, cu un stoc osos diminuat din cauza osteoporozei. Diagnosticul preliminar a fost stabilit în urma efectuării radiografi ilor simple. Stabilirea diagnosticului a impus efectuarea unei tomografi i computerizate și o reconstrucţie tridimensională a cotului. Intervenţia chirurgicală a fost efectuată în urma analizei datelor imagistice, practicându-se în primă etapă reducere și osteosinteză prin tehnica MIPO a fracturii de humerus proximal, ulterior reducerea și osteosinteza fracturii de humerus distal, plombajul defectului osos cu substituent și hobanajul olecranului osteotomizat. Lezarea redusă a ţesuturilor moi, reducerea durerii postoperator, diminuarea gradului de insufi cienţă funcţională și protejarea nervului axilar conferă superioritate osteosintezei prin abordul miniminvaziv (MIPO) faţă de abordul transdeltoidian. Cuvinte cheie: MIPO, reconstrucţie 3D tomografi e computerizată, poliartrită reumatoidă, fractura humerus proximal, fractură humerus distal CASE REPORT

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Triceps-sparing extra-articular step-cut olecranon osteotomy for distal humeral fractures: an anatomic study

Cited by 10 publications

References 31 publications

Comparison of the Visible Articular Surface between the Lateral Para-Olecranon Approach and Two Other Common Posterior Approaches for Distal Humeral Fracture: an Anatomical Study

Comparison of the Visible Articular Surface between the Lateral Para-Olecranon Approach and Two Other Common Posterior Approaches for Distal Humeral Fracture: an Anatomical Study

A biomechanical study comparing the mean load to failure of two different osteosynthesis techniques for the Step-Cut Olecranon Osteotomy

Proximal and Distal Humerus Fractures in a Patient with Chronic Inflammatory Joint Disease Undergoing Biologic Therapy

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