Paratricepital approach for fixation of distal humerus fracture in adults - A good alternative

Abstract

Objective: Distal humerus fractures most commonly managed by surgical approaches that disrupt the extensor mechanism of elbow. Paratricepital posterior approach for distal humerus fracture fixation done by orthogonal or parallel plate construct. Methods: 30 cases of distal humerus fractures are taken. Bicolumnar fixation done by elevating and retracting the triceps of the distal humerus keeping triceps insertion undisturbed by orthogonal or parallel plate construct. Early active-assisted range of motion initiated within limits of pain. Age group was 15 to 60 years. Among all patients 10% of fractures were Type C1, 6.66% of fractures were Type C2, Type A 50% and Type B fractures is 33.33%.Radiograph (x-ray) and functional evaluation was done by MEPS (Mayo Elbow Performance Score), DASH (Disability of Arm Shoulder and Hand) questionnaire. Results: All thirty fractures healed primarily. The median arc of elbow motion was 1150 (range 700 to 1400) with standard deviation of 1.33. Average score is 91(range 80-105) with standard deviation of 1.66, indicating excellent result. Conclusions: Paratricepital posterior approach results in excellent healing, a mean flexion extensor arc of more than 100 degree, maintenance of almost normal elbow extensor strength. Implication: Paratricepital posterior approach should be considered whenever distal humerus fracture are to be fixed especially in Type A and Type B fractures.