Treatment of AO Type C Fractures of the Distal Part of the Humerus through the Bryan-Morrey Triceps-Sparing Approach

Several alternative approaches have been described to avoid the complications related to the olecranon osteotomy used to treat distal articular humerus fractures. The published experience with the triceps-sparing approach is scant. In this prospective study, a total of 12 patients with an articular humeral fracture were treated using this approach. At a mean followup of 1,7 years, the average range of motion was 112.8° (range from 85° to 135°); the elbow flexion averaged 125.5° (range from 112° to 135°) and the deficit of elbow extension 14.6° (range from 0° to 30°). All the elbows were stable. The Mayo Elbow Performance Score (MEPS) averaged 93.3 (range from 80 to 100). In the present series no failure of the triceps reattachment to the olecranon was found, and all the patients recalled returning to their previous daily life activities without impairment with a satisfactory MEPS. As a conclusion, the triceps-sparing approach can be considered for treating distal articular humerus fractures. We consider that three clinical settings can be more favorable to use this approach: those cases in which a total elbow prosthesis might be needed, cases of ipsilateral diaphyseal fracture, or presence of previous hardware in the olecranon. 1. Introduction The treatment of intraarticular distal humerus fractures is subject of continuous debate in the orthopaedic literature [1–13]. They are uncommon, the anatomy is complex, and bone is frequently comminuted [14, 15]. It explains why these fractures pose a significant challenge for the orthopaedic surgeon. The nowadays debate is related to the type of treatment (open reduction and plate osteosynthesis versus arthroplasty), to the type of plating in case of osteosynthesis (parallel versus perpendicular), and to the surgical approach [3]. Although the posterior approach using the olecranon chevron osteotomy is considered the gold standard [3, 4, 11, 16, 17], the reconstruction of the osteotomy may lead to complications. These complications include delayed union, wound dehiscence, nonunion, malunion, hardware failure, and pain secondary to prominent hardware (Table 1). Alternative approaches to avoid these complications have been reported during the last years, such as the triceps-splitting [9, 18], triceps-reflecting anconeus pedicle [15, 19], the anconeus-flap transolecranon approach [20], and the triceps-sparing approach [21]. Table 1: Reported complications related to the olecranon osteotomy approach for the treatment of distal humerus fractures AO type C. To our best knowledge, there is only one recent study