Ailani R, Bhuyan SK, Prasad BK, Kumar A, Dawani N. Clinical outcomes of triceps reflecting anconeus pedicle and olecranon osteotomy approach for distal humerus intercondylar fractures. World J Orthop 2024; 15(6): 570-577 [PMID: 38947270 DOI: 10.5312/wjo.v15.i6.570]
Corresponding Author of This Article
Amit Kumar, MS, Associate Professor, Department of Orthopaedics, All India Institute of Medical Sciences, Kalyani, Room No. 301, Type 5 Quarter, West Bengal 741245, India. amitdr87@gmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Prospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Rohit Ailani, Department of Orthopaedics, Lovee Shubh Hospital, Lucknow, Uttar Pradesh 226002, India
Sanjeev Kumar Bhuyan, Department of Orthopaedics, Gauhati Medical College, Guahati 781032, India
Brejesh Kumar Prasad, Department of Orthopaedics, ESIC Medical College and Hospital, Faridabad, Haryana 121001, India
Amit Kumar, Department of Orthopaedics, All India Institute of Medical Sciences, Kalyani, West Bengal 741245, India
Namrata Dawani, Department of Obstetric and Gynecology, Kannauj Medical College, Kannauj, Uttar Pradesh 209732, India
Co-first authors: Rohit Ailani and Sanjeev Kumar Bhuyan.
Author contributions: Ailani R and Bhuyan SK contributed equally; Ailani R designed the study; Bhuyan SK performed the operations; Kumar A and Prasad BK drafted the manuscript; Dawani N contributed to statistical analysis.
Institutional review board statement: The study was reviewed and approved by the Gauhati Medical College and Hospital, Guwahati. This study was registered in the parent institute’s ETHICAL REGISTER (ID No.02/2015/228 dated 5-Dec-2015).
Informed consent statement: All subjects understood and agreed to the study protocol and voluntarily signed the informed consent form.
Conflict-of-interest statement: All the authors report having no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: Https://creativecommons.org/Licenses/by-nc/4.0/.
Corresponding author: Amit Kumar, MS, Associate Professor, Department of Orthopaedics, All India Institute of Medical Sciences, Kalyani, Room No. 301, Type 5 Quarter, West Bengal 741245, India. amitdr87@gmail.com
Received: December 7, 2023 Revised: April 14, 2024 Accepted: April 26, 2024 Published online: June 18, 2024 Processing time: 188 Days and 7.5 Hours
Abstract
BACKGROUND
The preferred treatment for distal humeral intercondylar fractures is open reduction and internal fixation. While there is consensus about the posterior approach, several posterior approaches have been developed. It is debatable as to which approach is best.
AIM
To compare triceps reflecting anconeus pedicle (TRAP) and olecranon osteotomy approaches for internal fixation of distal humeral intercondylar fracture.
METHODS
In total, 40 cases of Arbeitsgemeinschaft für Osteosynthesefragen/Association of the Study of Internal Fixation type C, closed, and Gustilo type I intercondylar humeral fractures were included. Patients ranged in age from 18 years to 70 years. The patients were randomized into two groups: TRAP group and olecranon osteotomy group, with 20 cases in each. All were followed up at 6 wk, 3 months, 6 months, and 12 months. Functional outcomes were measured in terms of flexion-extension arc, Disabilities of Arm, Shoulder and Hand score, and Mayo Elbow Performance Score.
RESULTS
The mean age was 43.2 years in the TRAP group and 37.5 years in the olecranon osteotomy group. The mean operative time and mean duration of hospital stay in the TRAP group were significantly higher than in the olecranon osteotomy group (119.5 vs 111.5 min and 9.85 vs 5.45 d, respectively). The mean arc of flexion-extension, Disabilities of Arm, Shoulder and Hand score, and Mayo Elbow Performance Score were comparable without any significant difference in the groups at the 12-month follow-up (107.0 vs 106.2, 18.3 vs 15.7, and 84.2 vs 86.2, respectively). Ulnar paresthesia and superficial infections were comparable in both groups (2 cases vs 3 cases and 3 cases vs 2 cases, respectively). Hardware prominence was significantly higher in the olecranon osteotomy group, mostly due to tension band wiring.
CONCLUSION
Both approaches were equivalent, but there is a need for further study including higher numbers of subjects and longer study duration to prove the benefits of one approach over the other.
Core Tip: The classical olecranon osteotomy approach for intra-articular and extra-articular distal humerus fractures provides excellent visualization of the fracture and allows for optimal reduction and adequate fixation of the fracture fragments. However, several complications, such as nonunion and hardware backout, are associated with this approach. Therefore, an alternative approach, such as the triceps reflecting anconeus pedicle, was developed. This study determined that the triceps reflecting anconeus pedicle and olecranon osteotomy approaches are similarly efficacious for internal fixation of distal humeral intercondylar fractures. Additional studies with more patients and a longer follow-up period are needed to determine the best approach.
