Triceps Reflection versus Olecranon Osteotomy Approach in Supracondylar Intercondylar Distal Humeral Fractures Managed by Open Reduction and Internal Fixation in Adults
Walid Samy Fathi Mohamed *
Orthopedic Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Mohamed Shafik Saaid
Orthopedic Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Ashraf Atif Mohamed
Orthopedic Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Ali Mahmoud Emran
Orthopedic Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
*Author to whom correspondence should be addressed.
Abstract
Background: Intercondylar fracture humerus needs early treatment consequently, the surgical approach becomes very crucial. Many approaches have been described for this fracture type. Approaches such as triceps-reflecting and olecranon osteotomy are frequently used.
Aim of Work: Is to assess the functional and radiological outcomes of olecranon osteotomy and triceps reflection in adults with supracondylar intercondylar distal humerus fractures treated with double plating.
Patients and Methods: To achieve the study's goal, a non-randomized controlled clinical trial was used. Patients with supracondylar intercondylar humerus fractures were admitted to Tanta University's orthopedic department and Cairo's El-Helal hospital. Total number of cases (21 patients) included in the study as a thorough sample during the research period (6 months). The medical records and radiographs of 13 male and 8 female patients, all above the age of 18, were prospectively evaluated after a 6-month follow-up period. Triceps reflection was performed on 52.4 percent of patients, while olecranon osteotomy was performed on 47.6 percent. The results of treatment were evaluated using a modified version of Mayo-Elbow performance score (MEPS).
Results: All the patients were assessed both before and after surgery. In the triceps-reflection group, 9 patients regarded good, 1 got excellent, and 1 got fair MEPS, whereas in the olecranon-osteotomy group, 7 patients got good, 1 got fair, and 2 got excellent MEPS. The olecranon-osteotomy technique gives greater control over the elbow joint and better visualization, especially if with C3 type. The functional results of distal humerus fractures disclosed by the triceps-reflection and olecranon-osteotomy approaches were comparable.
Conclusion: In C3 type, the olecranon-osteotomy technique offers more control over the elbow joint and better visualization, whereas in other types, the triceps-reflection and olecranon-osteotomy approaches, in treatment of supracondylar intercondylar distal humerus fractures with triceps-reflection and olecranon-osteotomy both methods are safe.
Keywords: Triceps, sparing, olecranon