In intra-articular distal humeral fractures: can combined medial-lateral approach gain better outcomes than olecranon osteotomy? [Ulus Travma Acil Cerrahi Derg]
Ulus Travma Acil Cerrahi Derg. Ahead of Print: UTD-69486 | DOI: 10.14744/tjtes.2019.69486  

In intra-articular distal humeral fractures: can combined medial-lateral approach gain better outcomes than olecranon osteotomy?

Libiao Wei1, Haitao Xu2, Zhiquan An2
1Huadong Hospital Affiliated to Fudan University
2Department Ⅲ Of Traumatic Orthopedics Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, P.R China

Background: The research is aimed at evaluating the functional outcomes of intra-articular distal humeral fractures treated through combined medial-lateral approach and comparing with olecranon osteotomy simultaneously.
Methods: 62 distal humeral fractures patients were assessed retrospectively. The olecranon osteotomy was used in 30 cases (14 males, 16 females) and combined medial-lateral in 32 cases (15 males, 17 females). The outcomes of function were assessed by the Mayo Elbow Performance Score (MEPS) and the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire score. The follow-up time was 15.4±3.5 months (range 10-24 months) for combined medial-lateral group and 14.6±2.6 months (range 10-20 months) for olecranon osteotomy. Level of Evidence: Level Ⅲ, retrospective study.
Results: The flexion–extension of elbows was 115.3°±16.1° in the combined medial-lateral group and the olecranon osteotomy group was 110.1°±15.2°. A significant difference was observed between the two groups for flexion–extension of the elbows (p=0.041). Pronation–supination of the forearms had a significant difference (p=0.025) between the combined medial-lateral group (160.6°±7.2°) and the olecranon osteotomy group (154.1°±9.3°). Mean MEPS, DASH, excellent and good rate and complication rate for combined medial-lateral approaches were 88.6±6.9 points, 9.8±6.6 points, 90.6% and 9.4%, respectively. Significant differences weren’t noted between the two groups for mean MEPS, DASH scores and excellent and good rate (p=0.594, p=0.505, p=0.934, respectively) except complication rate (p=0.005).
Conclusions: The combined medial-lateral approach is a successful approach in the treatment of intra-articular distal humeral fractures(especially type C1 and C2) that provides better outcomes for the motion of elbow, bleeding volume in surgery and complications than olecranon osteotomy.

Keywords: Distal humerus, surgical approach, combined medial-lateral approach, olecranon osteotomy, functional outcomes, complication




Corresponding Author: Zhiquan An, China


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