Introduction: Distal humerus fractures constitute 2 to 7% of all the elbow fractures. Young males are most commonly affected due to high energy trauma and secondly seen in elderly women due to osteoporosis. Due to complex anatomy and neurovascular network nearby, the treatment is very difficult. Anatomical reconstruction is the key for successful functional outcome. We compared the TRAP and olecranon osteotomy approach for the management of intraarticular fractures of the humerus in terms of functional, clinical and radiological outcome.
Materials and Methods: The study was conducted in the Department of Orthopaedics & Traumatology, MGM Medical College and MY Hospital, Indore from August 2019 to August 2021 on 30 patients with intra-articular fractures of humerus. 15 patients were treated with olecranon osteotomy and 15 patients were treated with TRAP approach, on patients fulfilling all the inclusion, but none of the exclusion criteria. The functional outcome was measured using Mayo Elbow Performance Score (MEPS) and radiographs were used for evaluating the bone union time.
Results: There was a male predominance. Assault, fall and road traffic accidents were the modes of injury. 13-B2, 13-C1 and 13-C3 were commonly seen fracture types. Mean MEPS was significantly better in TRAP (P0.05). 73.3% patients of TRAP and 64.3% patients of olecranon osteotomy group achieved excellent outcome by 6 months.
Conclusion: TRAP approach is comparatively better than osteotomy approach. Both the methods provide a stable fracture fixation, but complications are more in osteotomy in comparison to TRAP and we found TRAP to be functionally better.
Abbreviations: TRAP-triceps reflecting anconeus pedicle approach, MEPS-Mayo Elbow Performance Score, DASH-disabilities of the arm, shoulder and hand, POP-plaster of Paris
Olecranon osteotomy, TRAP (triceps reflecting anconeus pedicle approach), Intercondylar fractures, Mayo elbow performance score.