Purpose
To assess the outcomes of the lateral para-olecranon triceps-splitting approach for
the treatment of distal humeral fracture.
Methods
Ten patients (3 males, 7 females) with a mean age of 59 years were retrospectively
reviewed. There were 2 A2, 3 C1, and 5 C2 fractures according to the AO/ASIF classification.
Types B3 and C3 fractures were excluded from this study because the olecranon osteotomy
approach was indicated to visualize the anterior fragment. The triceps was split at
the midline, and the anconeus muscle was incised from the proximal ulna. The lateral
half of the triceps along with anconeus was retracted laterally as a single unit.
The distal part of the humerus could be visualized from medial and lateral windows
by retracting the medial half of the triceps. The articular fragment was anatomically
reduced and fixed temporarily with a Kirschner wire, and the reconstructed distal
articular block was then fixed to the humeral shaft with double locking plates.
Results
After surgery, average elbow flexion was 127° (range, 110°–145°), and extension was –10°
(range, –20°–0°) at the average follow-up time of 12.4 months (range, 8‒20 months).
Seven patients had normal muscle strength against full resistance (manual muscle testing
grade 5), and the other 3 patients had slightly reduced muscle strength (grade 4).
No articular stepoffs of more than 1 mm were seen on postoperative radiographs. There
were no cases of triceps insufficiency and nonunion. The average (± SD) Mayo Elbow
Score was 93.5 ± 5.8 points at the final follow-up.
Conclusions
The lateral para-olecranon approach is useful for the management of selected fractures
of the distal humerus, preserving extension strength and providing satisfactory clinical
outcomes, with no risk of olecranon osteotomy-related complications.
Type of study/level of evidence
Therapeutic V.
Key words
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Article info
Publication history
Published online: March 27, 2017
Accepted:
February 13,
2017
Received:
September 13,
2016
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2017 by the American Society for Surgery of the Hand. All rights reserved.
