Triceps Reflection versus Olecranon Osteotomy Approach in Supracondylar Intercondylar Distal Humeral Fractures Managed by Open Reduction and Internal Fixation in Adults

Background: Intercondylar fracture humerus needs early treatment consequently, the surgical approach becomes very crucial. Many approaches have been described for this fracture type. Approaches such as triceps-reflecting and olecranon osteotomy are frequently used.

Aim of Work: Is to assess the functional and radiological outcomes of olecranon osteotomy and triceps reflection in adults with supracondylar intercondylar distal humerus fractures treated with double plating.

Patients and Methods: To achieve the study's goal, a non-randomized controlled clinical trial was used. Patients with supracondylar intercondylar humerus fractures were admitted to Tanta University's orthopedic department and Cairo's El-Helal hospital. Total number of cases (21 patients) included in the study as a thorough sample during the research period (6 months). The medical records and radiographs of 13 male and 8 female patients, all above the age of 18, were prospectively evaluated after a 6-month follow-up period. Triceps reflection was performed on 52.4 percent of patients, while olecranon osteotomy was performed on 47.6 percent. The results of treatment were evaluated using a modified version of Mayo-Elbow performance score (MEPS).

Results: All the patients were assessed both before and after surgery. In the triceps-reflection group, 9 patients regarded good, 1 got excellent, and 1 got fair MEPS, whereas in the olecranon-osteotomy group, 7 patients got good, 1 got fair, and 2 got excellent MEPS. The olecranon-osteotomy technique gives greater control over the elbow joint and better visualization, especially if with C3 type. The functional results of distal humerus fractures disclosed by the triceps-reflection and olecranon-osteotomy approaches were comparable.

Conclusion: In C3 type, the olecranon-osteotomy technique offers more control over the elbow joint and better visualization, whereas in other types, the triceps-reflection and olecranon-osteotomy approaches, in treatment of supracondylar intercondylar distal humerus fractures with triceps-reflection and olecranon-osteotomy both methods are safe.