Outcome following olecranon osteotomy versus paratricipital approach for complex intra-articular (AO 13-C) fracture of distal humerus: a prospective comparative study.

Abstract

The paratricipital approach is a relatively new approach in a complex intra-articular fracture of distal humerus (AO13-C). The aim of this study was to ascertain this approach compared with the olecranon osteotomy approach. Also, we aimed to investigate whether advancing age and surgical delay yield a poor outcome. Between 2011 and 2015, 51 adult patients with closed AO 13-C-type fractures were included in the study and divided into 2 groups, that is, paratricipital approach (PT) group and olecranon osteotomy (OO) group. Patients were treated by 2 senior trauma surgeons. They were prospectively analyzed for outcome and complications. Mayo elbow performance score (MEPS) was used to evaluate the outcome. Of the total 51 patients (mean age, 41.6 years), 27 patients were in the PT group and 24 in the OO group. There was no difference in arc of motion (P = .513) and MEPS (P = .127) as well as complication rate (χ² statistic = 0.36, P = .54). However, specifically in the type C3 fracture, the PT group had a poor outcome for arc of motion (P = .002) and MEPS (P = .019) compared with the OO group. Also, age and surgical delay had a weak, negative correlation with arc of motion and MEPS. The association between age and surgical delay against arc of motion was statistically significant (P = .005 and .01, respectively). The PT approach and the OO approach can be used alternatively for AO 13-C1 and -C2 fractures with similar outcomes. However, in type C3, the PT approach yields a poor outcome in comparison with the OO approach.