Bilateral triceps tendon approach is flexible and efficient in the treatment of type C distal humerus fractures

Purpose:The purpose of this study was to assess and compare elbow range of motion,triceps extension strength and functional results of type C(AO/OTA)distal humerus fractures treated with bilateral triceps tendon(BTT)approach and olecranon osteotomy(00).At the same time,we are also trying to know whether BTT approach can provide sufficient vision for comminuted intra-articular fractures of the distal humerus,and whether it is convenient to convert to the treatment to total elbow arthroplasty(TEA)or 00.Methods:Patients treated with 00 and BTT approaches for type C distal humerus fractures between July 2014 and December 2017 were retrospectively reviewed.Inclusion criteria include:(1)patients'age were more than 18 years old,(2)follow-up was no less than 6 months,and(3)patients were diagnosed with type C fractures(based on the AO/OTA classification).Exclusion criteria include:(1)open fractures(Gustillo type 2 or type 3),(2)treated by other approaches,and(3)presented with combined injuries of ipsilateral upper extremities,such as ulnar nerve.Elbow range of motion and triceps extension strength testing were completely valuated,when the fractures had healed.Assessment of functional results using the Mayo elbow performance score and complications were conducted in final follow-up.The data were compared using the two tailed Student's t-test.All data were presented as mean±standard deviation.Results:Eighty-six patients of type C distal humerus fractures,treated by 00 and BTT approach were retrospectively reviewed between July 2014 and December 2017.Fifty-five distal humerus fractures(23 males and 32 females,mean age 52.7 years)treated by BTT approach or 00 were included in this study.There were 10 fractures of type Cl,16 type C2 and 29 type C3 according to the AO/OTA classification.Patients were divided into two surgical approach groups chosen by the operators:BTT group(28 patients)and 00 group(27 patients).And the mean follow-up time of all patients was 15.6 months(range,6-36 months).Three cases in BTT group were converted to TEA,and one converted to 00.Only one case in BTT group presented poor articular reduction with a step more than 2 mm.There were not significantly different in functional outcomes according to the Mayo elbow performance score,operation time and extension flexion motion are values between BTT group and 00 group(p>0.05).Complications and reoperation rate were also similar in the two groups.Triceps manual muscle testing were no significant difference in the two groups,even subdivided in elder patients(aged>60 years old).Conclusion:BTT is a safe approach to achieve similar functional result comparing with 00.BTT were not suitable for every case with severe comminuted pattern,but it avoids the potential complications related to 00,and has no complications concerning with triceps tendon.It is convenient for open reduction internal fixation and flexible to be converted to 00,as well as available to be converted to TEA in elder patients.

Lateral epicondyle osteotomy approach for coronal shear fractures of the distal humerus:Report of three cases and review of the literature

BACKGROUND Coronal shear fractures of the distal humerus are rare injuries and are technically challenging to manage.Open reduction and internal fixation(ORIF)has become the preferred treatment because it provides anatomical reduction,stable internal fixation,and early motion,but the optimal surgical approach remains controversial.CASE SUMMARY We report three cases of coronal shear fractures of the distal humerus treated successfully by ORIF via a novel surgical approach,in which lateral epicondyle osteotomy was performed based on the extended lateral approach.We named the novel surgical approach the lateral epicondyle osteotomy approach.All patients underwent surgical treatment and were discharged successfully.All patients had excellent functional results according to the Mayo elbow performance score.The average range of motion was 118°in flexion/extension and 172°in pronation/supination.Only case 2 had a complication,which was implant prolapse.CONCLUSION We demonstrated that the lateral epicondyle osteotomy approach in ORIF is effective and safe for coronal shear fractures of the distal humerus.

Percutaneous fixation of neonatal humeral physeal fracture: A case report and review of the literature

BACKGROUND Neonatal distal humeral physeal fractures are rare and difficult to diagnose.Thus,missed diagnoses and delayed healing are possible.Few studies have reported surgical treatment,because a callus may develop at the fracture site 5 d after the fracture,resulting in difficult reduction,and reduction of the limb may cause further physeal injury.Other surgical challenges include the provision of adequate anesthesia and complexity of the operation.However,without appropriate reduction and fixation,a varus elbow deformity may develop.Manual reduction and percutaneous pin fixation are ideal treatment options.CASE SUMMARY A 4-day-old neonate with left elbow pain accompanied by limited movement for 4 d was admitted,and diagnosed with delayed physeal fracture of the distal humerus based on physical examination,ultrasonography,and magnetic resonance imaging.The patient was treated by manual reduction combined with percutaneous pin fixation under arthrography.Postoperatively,the reduction was successful.The upper limbs could have been lifted and the fingers could have been moved freely on the second day after the operation.CONCLUSION The techniques of manual reduction and percutaneous pin fixation,to treat neonatal distal humeral physeal fractures,are safe and reliable.

Olecranon osteotomy vs.triceps-sparing for open reduction and internal fixation in treatment of distal humerus intercondylar fracture:a systematic review and meta-analysis

Background:The open reduction and internal fixation(ORIF)was a standard treatment approach for fracture at distal humerus intercondylar,whereas the optimal way before ORIF remains inconclusive.We,therefore,performed a systematic review and meta-analysis to assess the efficacy and safety of olecranon osteotomy vs.triceps-sparing approach for patients with distal humerus intercondylar fracture.Methods:The electronic searches were systematically performed in PubMed,EmBase,Cochrane library,and Chinese National Knowledge Infrastructure from initial inception till December 2019.The primary endpoint was the incidence of excellent/good elbow function,and the secondary endpoints included Mayo elbow performance score,duration of operation,blood loss,and complications.Results:Nine studies involving a total of 637 patients were selected for meta-analysis.There were no significant differences between olecranon osteotomy and triceps-sparing approach for the incidence of excellent/good elbow function(odds ratio[OR]:1.37;95%confidence interval[CI]:0.69-2.75;P=0.371),Mayo elbow performance score(weight mean difference[WMD]:0.17;95%CI:-2.56 to 2.89;P=0.904),duration of operation(WMD:4.04;95%CI:-28.60 to 36.69;P=0.808),blood loss(WMD:33.61;95%CI:-18.35 to 85.58;P=0.205),and complications(OR:1.93;95%CI:0.49-7.60;P=0.349).Sensitivity analyses found olecranon osteotomy might be associated with higher incidence of excellent/good elbow function,longer duration of operation,greater blood loss,and higher incidence of complications as compared with triceps-sparing approach.Conclusions:This study found olecranon osteotomy did not yield additional benefit on the incidence of excellent/good elbow function,while the duration of operation,blood loss,and complications in patients treated with olecranon osteotomy might be inferior than triceps-sparing approach.