Effectiveness comparison between the paratricipital approach and the chevron olecranon V osteotomy approach in the treatment of type C3 distal humeral fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Chuan ,  ZHANG Zuojun , CHANG Zhongxiao , YANG Linping , ZHAO Ming , LI Xingxing , WANG Guojie , DUAN Xiaobo

Center of Upper Limb Injury, Henan Provincial Luoyang Orthopedic-Traumatological Hospital & Henan Provincial Orthopedic Hospital, Luoyang Henan, 471002, P.R.China;

Corresponding author：

ZHANG Zuojun, Email: 249050882@qq.com

Keywords：

Elbow; humerus fracture; internal fixation; surgical approach

DOI：

10.7507/1002-1892.201803036

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ObjectiveTo compare the effectiveness between paratricipital approach and chevron olecranon V osteotomy approach for the treatment of type C3 (AO/OTA) distal humeral fractures and investigate the details of operation.MethodsBetween April 2010 and September 2016, 36 type C3 (AO/OTA) distal humeral fractures were treated with open reduction and bicolumnar orthogonal locking plating fixation by paratricipital approach and chevron olecranon V osteotomy approach respectively. The patients were divided into 2 groups by approach, there were 17 cases in paratricipital group (group A) and the bicolumns and distal humeral joint surface were exposed by traction of triceps and olecranon, and the distal humeral joint surface of the 19 cases in chevron olecranon V osteotomy group (group B) were exposed by osteotomy of the olecranon and reversing of triceps. There was no significant difference in gender, age, dominant side, interval between injury and surgery, causes of injury between 2 groups (P>0.05). Patients were followed up, the postoperative range of motion of elbow joint, strength, pain, and stability in 2 groups were documented and compared; the elbow joint function was evaluated according to Mayo elbow performance score (MEPS).ResultsThe operation time of group A [(115.0±10.4) minutes] was less than that of group B [(121.0±12.3) minutes], but there was no significant difference (t=–1.580, P=0.123). All patients in 2 groups got over 1 year follow-up and there was no significant difference of the follow-up time between 2 groups (t=–0.843, P=0.405). There was 1 case of heterotopic ossification in each group; 1 case of incision infection in group A and 1 case of incision superficial infection in group B, and were cured after 2 weeks of intravenous antibiotics administration. There was no other operative complications in the 2 groups. At 3 months after operation, all the distal humerus healed. At last follow-up, the elbow flexion extension range of groups A and B were (102.0±12.6)° and (99.5±10.1)° respectively, showing no significant difference (t=–0.681, P=0.501). The MEPS scores of groups A and B were 82.9±7.3 and 81.3±7.2 respectively, showing no significant difference (t=0.670, P=0.507); and the evaluation grade also showed no significant difference between 2 groups (Z=–0.442, P=0.659).ConclusionBy paratricipital approach and proper traction of the olecranon, the distal humeral articular surface can be exposed in the operation of type C3 distal humeral fractures, followed with same stable fixation after reduction, the effectiveness is equal to by chevron olecranon V osteotomy approach.

Citation： ZHANG Chuan, ZHANG Zuojun, CHANG Zhongxiao, YANG Linping, ZHAO Ming, LI Xingxing, WANG Guojie, DUAN Xiaobo. Effectiveness comparison between the paratricipital approach and the chevron olecranon V osteotomy approach in the treatment of type C3 distal humeral fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(10): 1321-1325. doi: 10.7507/1002-1892.201803036 Copy

1.	Erpelding JM, Mailander A, High R, et al. Outcomes following distal humeral gracture gixation with an extensor mechanism-on approach. J Bone Joint Surg (Am), 2012, 94(6): 548-553.
2.	Morry BF. The elbow and its disorders:functional evaluation of the elbow. 5th eds. Philadelphia: Saunders, 2017: 80.
3.	Foruria AM, Augustin S, Morry BF, et al. Heterotopic ossification after surgery for fractures and fracture-dislocations involving the proximal aspect of the radius or ulna. J Bone Joint Surg (Am), 2013, 95(10): e66.
4.	Flinkkilä T, Toimela J, Sirniö K, et al. Results of parallel plate fixation of comminuted intra-articular distal humeral fractures. J Shoulder Elbow Surg, 2014, 23(5): 701-707.
5.	Chen G, Liao Q, Luo W, et al. Triceps-sparing versus olecranon osteotomy for ORIF: analysis of 67 cases of intercondylar fractures of the distal humerus. Injury, 2011, 42(4): 366-370.
6.	罗忠纯, 刘凯, 宋春林, 等. 尺骨鹰嘴关节外截骨与关节内截骨治疗肱骨髁间骨折的疗效比较. 华西医学, 2015, 30(1): 26-29.
7.	Erpelding JM, Mailander A, High R, et al. Outcomes following distal humeral fracturefixation with an extensor mechanism-on approach. J Bone Joint Surg (Am), 2012, 94(6): 548-553.
8.	Arnander MW, Reeves A, MacLeod IA, et al. A biomechanical comparison of plate configuration in distal humerus fractures. J Orthop Trauma, 2008, 22(5): 332-336.
9.	Korner JK, Diederichs G, Arzdorf M, et al. A biomechanical evaluation of methods of distal humerus fracture fixation using locking compression plates versus conventional reconstruction plates. J Orthop Trauma, 2004, 18(5): 286-293.
10.	Kaiser T, Brunner A, Hohendorff B, et al. Treatment of supra- and intra-articular fractures of the distal humerus with the LCP Distal Humerus Plate: a 2-year follow-up. J Shoulder Elbow Surg, 2011, 20(2): 206-212.
11.	Schmidt-Horlohé K, Wilde P, Bonk A, et al. One-third tubular-hook-plate osteosynthesis for olecranon osteotomies in distal humerus type-C fractures: a preliminary report of results and complications. Injury, 2012, 43(3): 295-300.
12.	Jung SW, Kang SH, Jeong M, et al. Triangular fixation technique for bicolumn restoration in treatment of distal humerus intercondylar fracture. Clin Orthop Surg, 2016, 8(1): 9-18.
13.	Wiggers JK, Brouwer KM, Helmerhorst GT, et al. Predictors of diagnosis of ulnar neuropathy after surgically treated distal humerus fractures. J Hand Surg (Am), 2012, 37(6): 1168-1172.
14.	Worden A, Ilyas AM. Ulnar neuropathy following distal humerus fracture fixation. Orthop Clin North Am, 2012, 43(4): 509-514.
15.	Ruan HJ, Liu J, Fan CY, et al. Incidence, management, and prognosis of early ulnar nerve dysfunction in type C fractures of distal humerus. J Trauma, 2009, 67(6): 1397-1401.
16.	Chen RC, Harris DJ, Leduc S, et al. Is ulnar nerve transposition beneficial during open reduction internal fixation of distal humerus fractures? J Orthop Trauma, 2010, 24(7): 391-394.

1. Erpelding JM, Mailander A, High R, et al. Outcomes following distal humeral gracture gixation with an extensor mechanism-on approach. J Bone Joint Surg (Am), 2012, 94(6): 548-553.
2. Morry BF. The elbow and its disorders:functional evaluation of the elbow. 5th eds. Philadelphia: Saunders, 2017: 80.
3. Foruria AM, Augustin S, Morry BF, et al. Heterotopic ossification after surgery for fractures and fracture-dislocations involving the proximal aspect of the radius or ulna. J Bone Joint Surg (Am), 2013, 95(10): e66.
4. Flinkkilä T, Toimela J, Sirniö K, et al. Results of parallel plate fixation of comminuted intra-articular distal humeral fractures. J Shoulder Elbow Surg, 2014, 23(5): 701-707.
5. Chen G, Liao Q, Luo W, et al. Triceps-sparing versus olecranon osteotomy for ORIF: analysis of 67 cases of intercondylar fractures of the distal humerus. Injury, 2011, 42(4): 366-370.
6. 罗忠纯, 刘凯, 宋春林, 等. 尺骨鹰嘴关节外截骨与关节内截骨治疗肱骨髁间骨折的疗效比较. 华西医学, 2015, 30(1): 26-29.
7. Erpelding JM, Mailander A, High R, et al. Outcomes following distal humeral fracturefixation with an extensor mechanism-on approach. J Bone Joint Surg (Am), 2012, 94(6): 548-553.
8. Arnander MW, Reeves A, MacLeod IA, et al. A biomechanical comparison of plate configuration in distal humerus fractures. J Orthop Trauma, 2008, 22(5): 332-336.
9. Korner JK, Diederichs G, Arzdorf M, et al. A biomechanical evaluation of methods of distal humerus fracture fixation using locking compression plates versus conventional reconstruction plates. J Orthop Trauma, 2004, 18(5): 286-293.
10. Kaiser T, Brunner A, Hohendorff B, et al. Treatment of supra- and intra-articular fractures of the distal humerus with the LCP Distal Humerus Plate: a 2-year follow-up. J Shoulder Elbow Surg, 2011, 20(2): 206-212.
11. Schmidt-Horlohé K, Wilde P, Bonk A, et al. One-third tubular-hook-plate osteosynthesis for olecranon osteotomies in distal humerus type-C fractures: a preliminary report of results and complications. Injury, 2012, 43(3): 295-300.
12. Jung SW, Kang SH, Jeong M, et al. Triangular fixation technique for bicolumn restoration in treatment of distal humerus intercondylar fracture. Clin Orthop Surg, 2016, 8(1): 9-18.
13. Wiggers JK, Brouwer KM, Helmerhorst GT, et al. Predictors of diagnosis of ulnar neuropathy after surgically treated distal humerus fractures. J Hand Surg (Am), 2012, 37(6): 1168-1172.
14. Worden A, Ilyas AM. Ulnar neuropathy following distal humerus fracture fixation. Orthop Clin North Am, 2012, 43(4): 509-514.
15. Ruan HJ, Liu J, Fan CY, et al. Incidence, management, and prognosis of early ulnar nerve dysfunction in type C fractures of distal humerus. J Trauma, 2009, 67(6): 1397-1401.
16. Chen RC, Harris DJ, Leduc S, et al. Is ulnar nerve transposition beneficial during open reduction internal fixation of distal humerus fractures? J Orthop Trauma, 2010, 24(7): 391-394.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness comparison between the paratricipital approach and the chevron olecranon V osteotomy approach in the treatment of type C3 distal humeral fractures

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