Abstract:

Objective To compare the clinical efficacy of olecranon osteotomy approach vs lateral elbow approach for the treatment of transarticular coronal shear fracture of the distal humerus with reduction and internal fixation. Methods Sixty-two patients with transarticular coronal shear fracture of the distal humerus receiving open reduction and internal fixation surgery in our hospital from March 2016 to March 2021 were enrolled and assigned to two groups according to different surgical treatment methods. Control group （n = 32） received lateral elbow approach and treatment group （n = 30） received olecranon osteotomy approach. The general data， range of motion of the elbow joint， Mayo elbow performance score （MEPS）， and complications between two groups were compared. Results No statistical difference was found in surgical duration and bleeding volume between the two groups （P > 0.05）， while the incision length of treatment group was longer than that of the control group （P < 0.05）. Compared with the control group， Mayo scale was higher in treatment group at postoperative 1， 6 and 12 months （P < 0.05）. Compared with baseline data， the elbow flexion and extension range of motion improved in both groups at postoperative 12 months （P < 0.05）. Treatment group was followed up for 12 to 24 months， with a mean of （14.8 ± 2.2） months， and the bone healing time was 6 to 10 weeks with a mean of （10.8 ± 2.7） weeks. In control group， the follow up time ranged from 12 to 31 months， with a mean of （15.5 ± 3.1） months， and the bone healing time was 8 to 21 weeks with a mean of （12.4 ± 3.2） weeks. Treatment group had notably decreased time on bone healing compared with control group （P < 0.05）. No wound infection or vascular and nerve injury occurred in either group during the follow-up period. The incidence rate of joint stiffness， delayed fracture healing， traumatic arthritis， and heterotopic ossification yielded no statistical difference between the two groups （P > 0.05）. Conclusion Compared with lateral approach， the treatment of transarticular coronal shear fracture of the distal humerus with reduction and internal fixation via olecranon osteotomy approach had better elbow joint recovery， less complications and better short-term effects.

Key words: oecranon osteotomy approach, lateral elbow approach, open reduction and internal fixation surgery, clinical efficacy