Lateral Para-Olecranon Approach for the Treatment of Distal Humeral Fracture

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Abstract

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 The lateral half of the triceps along with anconeus was retracted laterally as a single unit.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.

Original languageEnglish
JournalJournal of Hand Surgery
DOIs
Publication statusAccepted/In press - 2016 Sep 13

Fingerprint

Olecranon Process
Humeral Fractures
Joints
Humerus
Muscle Strength
Elbow
Osteotomy
Bone Wires
Muscles
Ulna
Therapeutics
varespladib methyl

Keywords

  • Distal humeral fracture
  • Olecranon osteotomy
  • Surgical approach
  • Triceps-splitting

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

@article{9226d8d889e14ce48626623e6fdbd170,
title = "Lateral Para-Olecranon Approach for the Treatment of Distal Humeral Fracture",
abstract = "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.",
keywords = "Distal humeral fracture, Olecranon osteotomy, Surgical approach, Triceps-splitting",
author = "Takuji Iwamoto and Taku Suzuki and Noboru Matsumura and Masaya Nakamura and Morio Matsumoto and Kazuki Satou",
year = "2016",
month = "9",
day = "13",
doi = "10.1016/j.jhsa.2017.02.004",
language = "English",
journal = "Journal of Hand Surgery",
issn = "0363-5023",
publisher = "W.B. Saunders Ltd",

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TY - JOUR

T1 - Lateral Para-Olecranon Approach for the Treatment of Distal Humeral Fracture

AU - Iwamoto, Takuji

AU - Suzuki, Taku

AU - Matsumura, Noboru

AU - Nakamura, Masaya

AU - Matsumoto, Morio

AU - Satou, Kazuki

PY - 2016/9/13

Y1 - 2016/9/13

N2 - 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.

AB - 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.

KW - Distal humeral fracture

KW - Olecranon osteotomy

KW - Surgical approach

KW - Triceps-splitting

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