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Management of type 13C2 distal humerus fractures by olecranon osteotomy approach versus triceps sparing approach—our experience with sixty cases

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Abstract

Background

Intercondylar humerus fractures (AO type 13C), though less common (less than 1%), are increasing over the last few years. Open reduction and internal fixation (ORIF) of these fractures are now well recognised and preferred management. These fractures are principally approached from posterior side and various posterior approaches have been mentioned. Triceps sparing is a relatively newer approach for fixation of these fractures. Here, we are ascertaining the outcomes of triceps sparing approach and olecranon osteotomy approach and also investigating the preferred approach in various age groups.

Materials and methods

A level III non-randomized retrospective comparative study was conducted with a total of 60 patients belonging to AO type 13C2 in the age group of 16–70 years, operated upon during the period of September 2013 to March 2019. They were analysed for various outcome measures and complications. MEPS and DASH were used to determine outcome.

Results

Out of a total of 60 patients (mean age 37.52 years), 28 were in olecranon osteotomy (OO) group and 32 were in the triceps sparing (TS) group. The mean operative time for group OO was 93.11 ± 8.78 minutes compared with group TS where it was 77 ± 4.64 minutes and the difference was statistically significant. Similarly, blood loss was 224 ± 46 ml in group OO compared with 197 ± 39 ml in group TS and it was also statistically significant. The average MEPS score was slightly better in the group TS (86.56 ± 10.66) compared with group OO (83.57 ± 10.96), though not statistically significant. Similarly, DASH score was 35.72 ± 8.35 in group TS and 35.32 ± 8.89 in group OO. The MEPS score was excellent (≥ 90) in 12 patients of group OO and 16 patients of group TS, good (75–89) in 11 patients of each group and fair (60–74) in 5 patients of each group. The patients in the age group of ≥ 60 years tend to have inferior functional outcomes, though not statistically significant, when treated with triceps sparing approach compared with olecranon osteotomy approach.

Conclusion

In conclusion, we found that, compared with the olecranon osteotomy technique, better results though not statistically significant, can be expected with triceps sparing approach while treating type C2 distal humerus fractures in younger patients without significantly compromising the articular reduction or impairing stability of fracture fixation

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Authors and Affiliations

  1. Department of Orthopaedics, GSVM Medical College, Kanpur, Uttar Pradesh, India

    Mohammed Faheem Ansari & Nadeem Ashraf Khan

  2. Department of Orthopaedics, VMMC and Safdarjung Hospital, New Delhi, India

    A. Md. Atif

Authors
  1. Mohammed Faheem Ansari
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  2. Nadeem Ashraf Khan
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  3. A. Md. Atif
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Correspondence to Nadeem Ashraf Khan.

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Approval was obtained from the Ethics Committee of GSVM Medical College, Kanpur. The procedures in the study adhere to the tenets of the Declaration of Helsinki.

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Ansari, M.F., Khan, N.A. & Atif, A.M. Management of type 13C2 distal humerus fractures by olecranon osteotomy approach versus triceps sparing approach—our experience with sixty cases. International Orthopaedics (SICOT) 44, 2735–2742 (2020). https://doi.org/10.1007/s00264-020-04785-6

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  • DOI: https://doi.org/10.1007/s00264-020-04785-6

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