A study of functional outcomes of distal humerus fractures operated by triceps reflecting approach

  • Dr Vijay Sarukte Department of Orthopedics, K. B. Bhabha Hospital, Bandra, Mumbai, India
  • Dr. Ravi Bhanushali Department of Orthopedics, K. B. Bhabha Hospital, Bandra, Mumbai, India
  • Dr. Umesh Nagrale Department of Orthopedics, K. B. Bhabha Hospital, Bandra, Mumbai, India
  • Dr. Sunil Vishwakarma Department of Orthopedics, K. B. Bhabha Hospital, Bandra, Mumbai, India
Keywords: DASH Score, MAYO score, MRC grade, Triceps reflecting approach, Bryan Morrey approach, Distal Humerus fractures

Abstract

Introduction: Approaches to distal humerus has been a great controversy of which cheverons osteotomy is considered a gold standard. However it is associated with implant and procedure related complication, Hence we studied a triceps reflecting (Bryan –Morrey) approach with some modification so as to achieve good exposure to distal humerus with intact olecranon.

Methods: In our study we retrospectively studied 13 skeletally mature distal humerus fractures at our center treated by TRA with minimum follow up for a period of 3 months. They were functionally assessed with DASH Score, MAYO score, triceps power evaluation with MRC grading, measurements of ROM and Radiological union.

Results: Mean duration of follow up was Ten months in 13 patients, with an average age of 43.23 years. The mean Quick DASH score was 3.85, mean Mayo score was 89 indicating an good performance, mean Triceps muscle power MRC grading 5 with adequate mean functional ROM 23-114 degree(extension –flexion). Only 2 patients had complication of which one was screw breakage and other was wound dehiscence which was not related to approach.

Conclusion: TRA is a better option as it avoids creating a new fracture and preserving the joint anatomy as compared to olecranon osteotomy with adequate exposure of the joint to carry out the fixation. As from our series functional outcomes of strength of triceps is comparable with that of the other side.

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References

Babhulkar S, Babhulkar S. Controversies in the management of intra-articular fractures of distal humerus in adults. Indian J Orthop. 2011 May;45(3):216-25. doi: https://dx.doi.org/10.4103%2F0019-5413.80039.

Fernández-Valencia J, Muñoz-Mahamud E, Ballesteros J, Prat S. Treatment of AO Type C Fractures of the Distal Part of the Humerus through the Bryan-Morrey Triceps-Sparing Approach. ISRN Orthopedics. 2013;2013:1-6.

Pankaj A, Mallinath G, Malhotra R, Bhan S. Surgical management of intercondylar fractures of the humerus using triceps reflecting anconeus pedicle (TRAP) approach. Indian Journal of Orthopaedics. 2007;41(3):219.

Wilkinson JStanley D. Posterior surgical approaches to the elbow: A comparative anatomic study. Journal of Shoulder and Elbow Surgery. 2001;10(4):380-382.

Azboy I. The comparison of triceps-reflecting anconeus pedicle and olecranon osteotomy approaches in the treatment of intercondylar fractures of the humerus. Turkish Journal of Trauma and Emergency Surgery. 2015.

Mayo Elbow Performance Score. Journal of Orthopaedic Trauma. 2006;20(Supplement):S127.

Hudak P, Amadio P, Bombardier C, Beaton D, Cole D, Davis A et al. Development of an upper extremity outcome measure: The DASH (disabilities of the arm, shoulder, and head). American Journal of Industrial Medicine. 1996;29(6):602-608.

Henley MB, Bone LB, Parker B. Operative management of intra-articular fractures of the distal humerus. J Orthop Trauma. 1987;1(1):24-35.

Coles C, Barei D, Nork S, Taitsman L, Hanel D, Bradford Henley M. The Olecranon Osteotomy: A Six-year Experience in the Treatment of Intraarticular Fractures of the Distal Humerus. Journal of Orthopaedic Trauma. 2006;20(3):163-170.

Tak SR, Dar GN, Halwai MA, Kangoo KA, Mir BA. Outcome of olecranon osteotomy in the trans-olecranon approach of intra-articular fractures of the distal humerus. Ulus Travma Acil Cerrahi Derg. 2009 Nov;15(6):565-70.

Schmidt-Horlohé K, Wilde P, Bonk A, Becker L, Hoffmann R. One-third tubular-hook-plate osteosynthesis for olecranon osteotomies in distal humerus type-C fractures: a preliminary report of results and complications. Injury. 2012 Mar;43(3):295-300. doi: https://doi.org/10.1016/j.injury.2011.06.418. Epub 2011 Jul 22.

Bucholz RW. Rockwood and Green’s fractures in adults: Lippincott Williams & Wilkins Philadelphia; 2006.

Coulibaly NF, Tiemdjo H, Sane AD, Sarr YF, Ndiaye A, Seye S. Posterior approach for surgical treatment of neglected elbow dislocation. Orthop Traumatol Surg Res. 2012 Sep;98(5):552-8. doi: https://doi.org/10.1016/j.otsr.2012.03.006. Epub 2012 Aug 1.

Kasser J, Richards K, Millis M. The Triceps-Dividing Approach to Open Reduction of Complex Distal Humeral Fractures in Adolescents: A Cybex Evaluation of Triceps Function and Motion. Journal of Pediatric Orthopaedics. 1990;10(1):93-96.

Bryan RS, Morrey BF. Extensive posterior exposure of the elbow. A triceps-sparing approach. Clin Orthop Relat Res. 1982 Jun;(166):188-92.

Grogan BF, Blair JA, Blease RE, Cho MS, Hsu JR. Exposure of the distal humerus using a triceps hemi-peel approach. Orthopedics. 2014 May;37(5):e455-9. doi: https://doi.org/10.3928/01477447-20140430-56.

Guerroudj M, de Longueville J, Rooze M, Hinsenkamp M, Feipel V, Schuind F. Biomechanical properties of triceps brachii tendon after in vitro simulation of different posterior surgical approaches. Journal of Shoulder and Elbow Surgery. 2007;16(6):849-853. doi: https://doi.org/10.1016/j.jse.2007.02.137.

Ek E, Goldwasser M, Bonomo A. Functional outcome of complex intercondylar fractures of the distal humerus treated through a triceps-sparing approach. Journal of Shoulder and Elbow Surgery. 2008;17(3):441-446. doi: https://doi.org/10.1016/j.jse.2007.08.012.

Morrey BF, Askew LJ, Chao EY. A biomechanical study of normal functional elbow motion. J Bone Joint Surg Am. 1981 Jul;63(6):872-7.

Vasen AP, Lacey SH, Keith MW, Shaffer JW. Functional range of motion of the elbow. J Hand Surg Am. 1995 Mar;20(2):288-92.

Zhang C, Zhong B, Luo CF. Comparing approaches to expose type C fractures of the distal humerus for ORIF in elderly patients: six years clinical experience with both the triceps-sparing approach and olecranon osteotomy. Arch Orthop Trauma Surg. 2014 Jun;134(6):803-11. doi: https://doi.org/10.1007/s00402-014-1983-y. Epub 2014 Apr 29.

Doornberg JN, van Duijn PJ, Linzel D, Ring DC, Zurakowski D, Marti RK, Kloen P. Surgical treatment of intra-articular fractures of the distal part of the humerus. Functional outcome after twelve to thirty years. J Bone Joint Surg Am. 2007 Jul;89(7):1524-32.

A study of functional outcomes of distal humerus fractures operated by triceps reflecting approach
CITATION
DOI: 10.17511/ijmrr.2017.i02.02
Published: 2017-02-28
How to Cite
1.
Sarukte V, Bhanushali R, Nagrale U, Vishwakarma S. A study of functional outcomes of distal humerus fractures operated by triceps reflecting approach. Int J Med Res Rev [Internet]. 2017Feb.28 [cited 2021Jun.18];5(2):105-12. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/811
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