Comparative Analysis of Results of Paratricipital Approach and Olecranon Osteotomy in Non Comminuted Distal Humerus Fractures - A Retrospective Study Conducted at a Tertiary Hospital in Kolkata

Author(s): Subhadeep Ghosh1, Sunit Hazra2

Intercondylar humerus fractures and low transcondylar type fractures of distal
humeral often require surgical exposure and anatomical reduction of the articular
surface as well as stabilization of the medial and lateral columns of the distal
humerus. Traditionally, these injuries have been treated surgically with various
extensor mechanism-disrupting surgical approaches. These approaches have
often led to delayed union or non-union of the olecranon, triceps weakness, and
osteotomy-related prominent implants. To avoid these problems, various extensor
mechanism-sparing approaches that provide bicolumnar exposure of the distal
part of the humerus have been described, including triceps-splitting and reflecting
techniques. The paratricipital approach was developed to avoid the problems of
olecranon osteotomy approach for non comminuted distal humerus fractures.
The purpose of this study was to compare the paratricipital approach with
olecranon osteotomy and evaluate their effects on the functional outcomes of
intercondylar fractures of the distal humerus managed with open reduction and
internal fixation (ORIF) by reviewing 38 cases of intercondylar distal humerus
fractures surgically managed with either of the approaches during 2015 - 2017.
The retrospective study was conducted at our institution, R.G. Kar Medical College,
Kolkata from May 2015 to May 2017. OA type C1 and C2 fractures were included
in the study. Type C3 fractures were excluded from the study. Distal humeral open
reduction and internal fixation (ORIF) was performed with either orthogonal or
parallel plate constructs in 38 patients, where paratricipital approach was used in
21 patients and olecranon osteotomy was done for 17 patients.
Patients in the paratricipital approach group seems to have better range of motion
in terms of flexion and extension. Moreover, mayo elbow performance score
(MEPS) of the paratricipital group is better than that of olecranon osteotomy
group, even more so in younger age groups.
We found that ORIF via the paratricipital approach would confer better functional
outcomes for simple intra-articular distal humerus fractures in patients of all age