| Purpose To compare and analyse two kinds of posterior approach in the treatment of type C fracture of distal humerus with double perpendicular LCP fixation,by comparing the olecranon osteotomy and the triceps tongue flap approach of two kinds of operative time(min),bleeding volume(Ml),time of hospitalization(day),healing time(week)and postoperative follow-up function(degree)and complications of the treatment of distal humeral fractures occurred.Methods Retrospective statistics a total of 32 patients with type C distal humeral fractures treated in the Second Hospital Of Dalian Medical University from October 2014 to March 2016,with all the followed-up patients analyzed.Inclusive criteria: 1.Unilateral closed fracture distal humerus(AO type13-C);2.The injured arm has a normal elbow function before injury;3.18 years of age or older;4.Surgery with posterior median incision of olecranon osteotomy or triceps tongue flap approach;5.The internal fixation of fracture was treated with double vertical plate fixation;6.The patients can listen to the doctor’s advice,and the follow-up is enough.Exclusive criteria: 1.With history of elbow surgery;2.Obsolete fracture、open or pathological fracture;3.With severe vascular and nerve injury;4.With other parts of the fracture,the impact of functional rehabilitation;5.Failing to follow the doctor’s instructions for functional exercise or lost follow-up.32 cases of type C distal humeral fracture according to the standard were divided into the experimental group(Group A:Olecranon osteotomy)and the control group(Group B:Triceps tongue flap approach).There was no significant difference between the two groups in age,injury mechanism,fracture classification,and so on.The operation time,blood loss,hospital stay,union time,postoperative follow-up and complications were statistically analyzed and compared between the two groups.The patients were followed up for 2 weeks,1,3,6,12,18 months.We judge the union time and complications according to radiographs and physical examinations.The Mayo Elbow Performance Score(MEPS)was used to determine the elbow functional results 1 year after operation.Results All patients were followed up,the mean follow-up time is 13.4months(8months to 25months).Recording all the data of follow-up patients,with operation time(min),the amount of bleeding(ml),hospitalization time(day),healing time(week),joint flexion and extension(degree),postoperative follow-up Mayo score(point)and complications included.The patient treated by olecranon osteotomy approach gets a longer operation time and more blood loss than triceps tongue flap approach(P < 0.05),but gets a better elbow flexion and extension degree(P <0.05).There was no significant difference in union time(P>0.05).There are several postoperative complications appearing in both operative approaches.The patients with olecranon osteotomy approach,superficial infection occurred in 1 cases and healed after dressing change,another 2 cases of iatrogenic ulnar nerve injury symptoms and 1 patients with mild symptoms of heterotopic ossification appeared.The triceps tongue flap approach in patients with iatrogenic ulnar nerve injury,heterotopic ossification,1 cases of the stiff elbow.Conclusion This study compared the distal humerus C treatment of two kinds of surgical approach of double vertical plate fracture;more detailed records of treatment results and complications.The two approaches of the elbow can well expose the articular surface of the distal humeral fracture,and the double perpendicular plate can effectively fix the type C fracture of the distal humerus.Triceps tongue flap approach gets a smaller damage,but olecranon osteotomy approach gets better elbow function and less complications.However,good postoperative outcomes were related to the physician’s personal experience and patient compliance. |
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