Clinical Research

Clinical efficacy of olecranon osteotomy approach vs lateral elbow approach for the treatment of transarticular coronal shear fracture of the distal humerus with open reduction and internal fixation surgery

  • Chengnian ZHANG ,
  • Xuecheng LI ,
  • Zheng ZHANG ,
  • Daijie. ZHANG
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  • Department of Hand Surgery,Binzhou Medical University Hospital,Binzhou 256600,China

Received date: 2023-05-15

  Online published: 2023-11-22

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.

Cite this article

Chengnian ZHANG , Xuecheng LI , Zheng ZHANG , Daijie. ZHANG . Clinical efficacy of olecranon osteotomy approach vs lateral elbow approach for the treatment of transarticular coronal shear fracture of the distal humerus with open reduction and internal fixation surgery[J]. The Journal of Practical Medicine, 2023 , 39(19) : 2506 -2510 . DOI: 10.3969/j.issn.1006-5725.2023.19.016

References

1 OSHIKA Y, TAKEGAMI Y, TOKUTAKE K,et al. Ulnar Nerve Neuropathy After Surgery for Intraarticular Distal Humerus Fractures: An Analysis of 116 Patients[J]. J Hand Surg Am,2023,15(23):68-71.
2 胡健,刘红国,石鹏,等. 切开复位内固定治疗成人陈旧性肱骨小头-滑车冠状面骨折[J]. 中国骨与关节损伤杂志,2021,36(1):29-32.
3 XUE Z, HUANG X, GUO W,et al. Comparison of clinical outcomes between the olecranon osteotomy approach and the Bryan-Morrey approach for total elbow arthroplasty[J]. J Shoulder Elbow Surg,2023,21(23):262-268.
4 JEONG H S, YANG J Y, JEON S J,et al. Comparison of olecranon osteotomy and paratricipital approach in distal humerus intra-articular fracture: A systematic review and meta-analysis[J]. Medicine (Baltimore), 2022,101(34):e30216.
5 VICENTI G, BIZZOCA D, ZACCARI D,et al. Choice of treatments of the coronal shear fractures of the humerus. A national survey of Italian AO members[J]. Injury, 2023,54(1):S78-S84.
6 HOFMANN V, DIEPOLD J, MOURSY M,et al. Minimally invasive plate osteosynthesis (MIPO) for distal humeral fractures: a cadaveric study and first clinical application[J]. BMC Musculoskelet Disord,2023,24(1):206-208.
7 WEBER M B, CHO E, EVANS P J,et al. Triceps tongue versus olecranon osteotomy for intra-articular distal humeral fractures: a matched-cohort study[J]. J Shoulder Elbow Surg,2022,31(6):1215-1223.
8 PATEL S S, MIR H R, HOROWITZ E,et al. ORIF of Distal Humerus Fractures with Modern Pre-contoured Implants is Still Associated with a High Rate of Complications[J]. Indian J Orthop,2020,54(5):570-579.
9 查晔军,蒋协远,公茂琪. 肱骨远端骨性结构畸形的肘关节松解和阶梯治疗方案[J]. 中国医刊,2021,56(2):157-162.
10 WILSON E S, BUCKWALTER J A, HENNING G,et al. Inclusion of Olecranon Osteotomy With the Posterior Approach for Fixation of Distal Humerus Fractures (OTA/AO 13) Does Not Increase Surgical Complications[J]. J Orthop Trauma,2021,35(7):e223-e227.
11 YOSHII Y, IWABUCHI S, IKUMI A,et al. Correlations between 3D preoperative planning and postoperative reduction in the osteosynthesis of distal humeral fractures[J]. J Orthop Surg Res,2023,18(1):283-291.
12 阳曙东,陶建春,谭文甫,等. 肘前外侧入路治疗肱骨远端冠状面骨折的疗效[J]. 中南医学科学杂志,2022,50(2):241-244.
13 TING F S, HUANG A, POTRA R,et al. Morphology of Proximal Ulna Bare Area: A Guide for Olecranon Osteotomy[J]. J Hand Surg Am,2022,26(5):S0363-365.
14 CHANG A L, DIETERICH J D, DIPRINZIO E V,et al. Surgical Approach and Internal Fixation Techniques for Intra-Articular Distal Humerus Fracture With Coronal Shear Capitellar Fracture[J]. Tech Hand Up Extrem Surg,2020,25(1):25-29.
15 吴廷江,王晓滨,顾春阳. 不同手术入路方法治疗肱骨远端骨折临床效果比较[J]. 临床军医杂志,2021,4(7):750-751.
16 YOSHII Y, TERAMURA S, OYAMA K,et al. Development of three-dimensional preoperative planning system for the osteosynthesis of distal humerus fractures[J]. Biomed Eng Online,2020,19(1):56.
17 BITZER A M, BELKOFF S M, LIBRIZZI C L,et al. Sagittal plane alignment affects the strength of pin fixation in supracondylar humerus fractures[J]. Medicine (Baltimore),2021,100(22):e261-267.
18 HASAN S A, FISHER K, HENN R F,et al. Coronal Plane Articular Shear Fractures of the Distal Humerus[J]. J Am Acad Orthop Surg,2023,31(5):e235-e245.
19 BORBAS P, LOUCAS R, LOUCAS M,et al. Biomechanical stability of complex coronal plane fracture fixation of the capitellum[J]. Arch Orthop Trauma Surg,2022,142(11):3239-3246.
20 祝捷,杨运发,肖学军. Multiloc髓内钉与Philos钢板治疗Neer二,三部分肱骨近端骨折的疗效比较[J].实用医学杂志,2021,37(1):1450-1455.
21 KATAOKA T, YASUI Y, KURIYAMA K,et al. Parallel plate fixation for distal humeral fracture: Computer simulation to determine the appropriate screw insertion sequence[J]. J Orthop Sci. 2021,26(5):860-864.
22 CHONG H H, QURESHI A. Pediatric distal humeral supracondylar fracture-achievement of optimal pinning configuration[J]. Acta Orthop Belg,2022,88(2):245-254.
23 GENEROSO T O, PACíFICO JUNIOR G M, BARCELOS F M,et al. The trochlear physeal line angle: a novel method to assess coronal plane alignment of the paediatric distal humerus[J]. J Pediatr Orthop B,2022,31(5):422-430.
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