Clinical Research On Two Surgical Approaches For The Treatment Of Intercondylar Fractures

Objective: To compare the clinical outcomes on triceps-sparing approachand olecranon osteotomy approach for the open reduction and internal fixation(ORIF) of the intercondylar fractures. Method: In this study,71cases ofintercondylar distal humerus fractures surgically managed with either of theapproaches from August2008to October2010. The number of the patientswho were treated through the triceps-sparing approach is35, and the number ofthe patients who were treated through olecranon osteotomy approach is36.According to the AO Foundation (AO) classification, there were10cases of C1,30cases of C2and31cases of C3fractures. There were32males and39females with a mean age of46.5years (range,18~76years). The imaginationdata (X-Ray and3-dimensions CT scans) and the elbow function atpreoperative and postoperative were reviewed retrospectively. Flexion,extension, arc of flexion/extension, pronation, supination, arc ofpronation/supination and the Mayo Elbow Performance Score (MEPS) wereused to assess the clinical outcomes of intercondylar distal humerus fracturestreated with ORIF through the triceps-sparing approach or olecranon osteotomy.Results:71patients were followed up for an average of36.5m(6~87months).The rivewe showed that all the fractures had been clinical union, the mean timeis12weeks (8-18weeks). Although there was no overall statistically significantdifference in the average flexion, extension, arc of flexion/extension, pronation,supination and arc of pronation/supination between the triceps-sparing group (n=36) and the olecranon osteotomy group (n=35), patients above60years ofage tended to have more extension loss (mean24.5°, range0–55°) after ORIFvia the triceps-sparing approach, compared with any other surgical approach/age combination group. In the triceps-sparing group, although only44.4%of patients over the age of60years obtained excellent/good MEPS, therate increased to81.9%in patients aged41-60years old and the rate increasedto100%in patients aged less than40years of age (P <0.05). By contrast, therate of excellent/goodMEPS remained above80%in all age groups of patientstreated with ORIF via olecranon osteotomy. In the triceps-sparing group, onepatient (3%) had a clinically cubitus varus deformity but without anyinterference in elbow function; one patient (3%) had delayed bone union; fourpatients (12%) had postoperative arthritis, but one of them showingpreoperative arthritis; four patients (12%) showed ulnar nerve paraesthesia anddisappeared spontaneously by the fourth week post-operation; two patients (6%)had elbow stiffness, which have been resolved8weeks postoperatively. In theolecranon osteotomy group, four patients (12%) had heterotopic ossification ofthe elbow; two patients (6%) had delayed bone union; two patients (6%) hadulnar nerve paraesthesia, which bad been recovered by the third weekpost-operation; one patient (3%) with open fracture had superficial infection.There was no fixation failure in any of the patients. Conclusion: ORIF via theolecranon osteotomy approach confers superior functional outcomes forintercondylar distal humerus fractures in patients over the age of60years thanthe triceps-sparing approach. However, for patients less than60years of age,especially those less than40years of age, either approach confers satisfactoryoutcomes.