Published: 2020-06-23

Randomised prospective comparative analysis of functional outcome of osteosynthesis of intra-articular distal humerus fracture using triceps reflecting and transolecrenon approach

Nuthan Jagadeesh, Nibin Sanil, Vishwanath M. S.


Background: Intra articular fractures of distal humerus is one of the demanding injuries to manage due to its complex anatomy. Open reduction internal fixation is able to achieve painless, stable and mobile joint. This study is aimed at comparing functional outcome of patients treated with triceps reflecting and olecranon osteotomy approach.

Methods: A hospital based randomized comparative study of 40 patients who diagnosed with distal humerus intraarticular fracture admitted in our hospital from April 2017 to March 2019. Triceps reflecting approach (group A) was used in 20 patients and olecranon osteotomy approach (group B) in 20 patients. Elbow range of movements and Mayo elbow performance score (MEPS) was used to compare outcome.

Results: The mean elbow range of motion is 95.8±13.5 degree at 1 year follow up in group A and 94.5±9.3 degree in 1 year follow up at 1 year follow up in group B. The mean MEP score at end of 1 year in group A was 93.8±2.9 and in group B was 91.5±3.2 shows excellent results but there was no statistically significant difference between MEP scores of two groups. We observed 6 patients developed extension lag less than 10 degree in group A which was clinically insignificant to patients and 7 patients developed hardware prominence in group B.

Conclusions: Triceps reflecting Bryan Morrey approach is equally effective as olecranon osteotomy approach in treatment of distal humerus intra articular fracture with less complication and operative time.


Intra-articular distal humerus fracture, Mayo elbow score, Tricep reflecting approach, Olecrenon osteotomy

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Rose SH, melton LJ, Morrey BF, Ilstrup DM, Riggs BL. Epidemiologic features of distal humral fracture. Clin orthop Relat Res. 1982;168:24-30.

Palvanen M, Kannus P, Niemi S. Secular trends in the osteoporotic fractures of the distal humerus in elderly women. Eur J Epidemiol. 1998;14(2):159-64.

Islam SU, Glover AW, Waseem M. Challenges and Solutions in Management of Distal Humerus Fractures. Open Orthopaedics J. 2017;11(1):1292-1307.

Robinson CM, Hill RM, Jacobs N. Adult distal humeral metaphyseal fractures: epidemiology and results of treatment. J Orthop Trauma. 2003;17(1):38-47.

Batten TJ, Hidge SC, Brinsden MD, Guyver PM. Non-operative management of distal humerus fractures in the elderly: a review of functional outcomes. Eur J Orthop Surg Traumatol. 2018;28(1):23-7.

Brown CCM. Rockwood and Greens fractures in adults. Philadelphia: Wolters Kluwer; 2015.

Henley MB. Intra-articular distal humeral fractures in adults. Orthop Clin North Am. 1987;18:11-23.

Jupiter JB, Neff U, Holzach P, Allgower M. Intercondylar fractures of the humerus. An operative approach. J Bone Joint Surg. 1985;67:226-39.

McKee MD, Wilson TL, Winston L, Schemitsch EH, Richards RR. Functional outcome following surgical treatment of intra-articular distal humeral fractures through a posterior approach. J Bone Joint Surg. 2000;82:1701-7.

Cheung EV, Steinmann SP. Surgical approaches to the elbow. J Am Acad Orthop Surg. 2009;17:325-33.

Gofton WT, Macdermid JC, Patterson SD. Functional outcome of AO type C distal humeral fractures. J Hand Surg Am. 2003;28:294-308.

Holdsworth BJ, Mossad MM. Fractures of the adult distal humerus. Elbow function after internal fixation. J Bone Joint Surg Br. 1990;72:362-5.

Sodergard J, Sandelin J, Bostman O. Postoperative complications of distal humeral fractures. 27/96 adults followed up for 6 (2-10) years. Acta Orthop Scand. 1992;63:85-9.

Pierce TD, Herndon JH. The triceps preserving approach to total elbow arthroplasty. Clin Orthop Relat Res. 1998;354:144-52.

Celli A, Arash A, Adams R, Morrey BF. Triceps insufficiency following total elbow arthroplasty. J Bone Joint Surg Am. 2005;87:1957-64.

Hildebrand KA, Patterson SD, Regan WD, MacDermid JC, King GJ. Functional outcome of semi-constrained total elbow arthroplasty. J Bone Joint Surg Am. 2000;82:13791386.

Ek ET, Goldwasser M, Bonomo AL. Functional outcome of complex intercondylar fractures of the distal humerus treated through a triceps-sparing approach. J Shoulder Elbow Surg. 2008;17:441-6.

Driscoll OSW. The triceps-reflecting anconeus pedicle (TRAP) approach for distal humeral fractures and non-unions. Orthop Clin North Am. 2000;31:91-101.

Mayo Elbow Performance Score. J Orthopaedic Trauma. 2006;20(8):127.

McCormack HM, Horne DJ, Sheather S. Clinical applications of visual analogue scales: a critical review. Psychol Med. 1988;18:1007-19.

Gupta G, Ghosh S, Chaudhuri A, Datta S, Dutta S, Dugar N. Comparative study of different approaches for open reduction and internal fixation in fractures of distal humerus. Saudi J Sports Med. 2015;15:68-73

Krishna RK, Aradhana TR, Preetham N. A comparative study of olecranon osteotomy approach and triceps reflecting approach in osteosynthesis of distal humerus fracture in adults. Indian J Orthopaedics Surg. 2015;1(1):60-3.