[Effectiveness comparison between the paratricipital approach and the chevron olecranon V osteotomy approach in the treatment of type C3 distal humeral fractures].

Objective: To compare the effectiveness between paratricipital approach and chevron olecranon V osteotomy approach for the treatment of type C3 (AO/OTA) distal humeral fractures and investigate the details of operation.

Methods: Between April 2010 and September 2016, 36 type C3 (AO/OTA) distal humeral fractures were treated with open reduction and bicolumnar orthogonal locking plating fixation by paratricipital approach and chevron olecranon V osteotomy approach respectively. The patients were divided into 2 groups by approach, there were 17 cases in paratricipital group (group A) and the bicolumns and distal humeral joint surface were exposed by traction of triceps and olecranon, and the distal humeral joint surface of the 19 cases in chevron olecranon V osteotomy group (group B) were exposed by osteotomy of the olecranon and reversing of triceps. There was no significant difference in gender, age, dominant side, interval between injury and surgery, causes of injury between 2 groups ( >0.05). Patients were followed up, the postoperative range of motion of elbow joint, strength, pain, and stability in 2 groups were documented and compared; the elbow joint function was evaluated according to Mayo elbow performance score (MEPS).

Results: The operation time of group A [(115.0±10.4) minutes] was less than that of group B [(121.0±12.3) minutes], but there was no significant difference ( =–1.580, =0.123). All patients in 2 groups got over 1 year follow-up and there was no significant difference of the follow-up time between 2 groups ( =–0.843, =0.405). There was 1 case of heterotopic ossification in each group; 1 case of incision infection in group A and 1 case of incision superficial infection in group B, and were cured after 2 weeks of intravenous antibiotics administration. There was no other operative complications in the 2 groups. At 3 months after operation, all the distal humerus healed. At last follow-up, the elbow flexion extension range of groups A and B were (102.0±12.6)° and (99.5±10.1)° respectively, showing no significant difference ( =–0.681, =0.501). The MEPS scores of groups A and B were 82.9±7.3 and 81.3±7.2 respectively, showing no significant difference ( =0.670, =0.507); and the evaluation grade also showed no significant difference between 2 groups ( =–0.442, =0.659).

Conclusion: By paratricipital approach and proper traction of the olecranon, the distal humeral articular surface can be exposed in the operation of type C3 distal humeral fractures, followed with same stable fixation after reduction, the effectiveness is equal to by chevron olecranon V osteotomy approach.