Pedical approach for intraarticular lower end humerus fractures
Background: Operative fixation of intra-articular fractures of the distal humerus requires adequate exposure. The transolecranon approach is a commonly used approach. The olecranon osteotomy has potential complications related to prominence/ migration of hardware, displacement/ nonunion of osteotomy and triceps weakness. Triceps reflecting anconeus pedicle (TRAP) avoids the olecranon osteotomy without compromising the operative exposure. We present outcome of fixation of displaced intra-articular distal humeral fractures with the use of TRAP approach.
Materials and Methods:We prospectively reviewed results of TRAP approach on cohort of 30 patients with intraarticular fracture lower end humerus over a duration of June 2012 to Aug. 2014. Results were evaluated on clinical grounds by Mayo Elbow Performance Index for functional recovery,stability, triceps strength and on radiological ground with mean follow-up of 12 month.
Results: In cohort of 30 patients (18 male, 12 female) more than 95 %showed good clinical or functional results on Mayo Elbow Performance Index. Patients were assessed for the functional status of the elbow joint and We found that 80% of them had a range of flexion as given by the Mayo classification of more than 100 degrees. The extension in 85% of the patients was more than 5 degrees in regard to range of motion and . Long term follow up of 6 months for triceps strength gave encouraging results as 96% had strengths in the range of 4-5 and none of them had triceps rupture. Radiological evaluation showed union in all . No patient needed a reoperation and none of them showed elbow instability or tricep weakness.
Conclusions: The TRAP approach provides good visualization for fixation of intercondylar fractures of the humerus, without any noticeable untoward effect on triceps strength and postoperative rehabilitation; and one can avoid iatrogenic fractureof the olecranon and its associated complications
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