Surgical management of intra-articular fractures of distal humerus in adults using triceps reflecting anconeus pedicle approach (trap)
Introduction: Intra-articular fractures of distal humerus constitute 0.5% - 0.7% of all the fractures and 30% of elbow fractures. Exposure of distal humerus via posterior approach is dependent on the triceps mobilization and there are many other modifications e.g. olecranon osteotomy, triceps splitting, triceps reflecting, paratricipital.
Aim: To evaluate functional outcome of fixation of displaced intra-articular distal humeral fractures with use of triceps-reflecting anconeus pedicle approach.
Materials and Methods: 28 patients (16 males and 12 females) of closed intra-articular fractures of distal humerus were treated by open reduction and internal fixation with plate and screws using TRAP approach. Fractures were classified using A.O. classification. Mean age of the patients was 37 yrs(18-62 yrs). All open fractures, injuries older than 3 weeks, associated bony injuries of ipsilateral limb were excluded from the study. Passive and active Elbow mobilization exercises were started after stitch removal. Patients were advised to keep the extremity supported in a splint in between exercises which was discarded after 6-8 weeks. Average period of follow up was 9 months. Patients were evaluated using Mayo Elbow performance index.
Results: As per Mayo index results were excellent in 9 patients, good in 13 patients and fair in 4 patients and poor in 2 patients. Average arc of motion at elbow was 101.300. None of the patients had weakness of triceps. Most common complication was discomfort because of hardware prominence.
Conclusion: TRAP approach allows adequate fracture visualization of distal humerus for stable fixation of intra-articular fractures without creating an iatrogenic fracture of olecranon and its associated complications.
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