Management of supracondylar/intercondylar distal humerus fractures using triceps-reflecting anconeus pedicle approach

Abstract

Introduction: Chevron olecranon osteotomies are commonly used for intra-articular distal humerus fractures but are often associated with complications such as prominence of hardware, displacement, and nonunion of osteotomy. We studied the triceps-reflecting anconeus muscle pedicle approach (TRAP) with preservation of the extensor apparatus as a safe alternative, giving a sufficient exposure to the elbow joint. Materials and Methods: We reviewed the functional and radiological results of thirty consecutive patients with intercondylar fractures of the humerus treated by internal fixation through TRAP approach. The average age of the patients was 32 ± 4.5 years. Results: At a minimum follow-up of 12 months (average 18 ± 4 months), 27 (90%) patients had good triceps strength. The average range of motion was 118.4° ± 7° (range, 80°–130°). The average time to union was 3.2 ± 1.6 months. No patient had triceps rupture, implant failure, neurovascular deficit, or nonunion. One patient needed removal of the implant because of subcutaneous prominence. Conclusion: TRAP approach provides good visualization for fixation of intercondylar fractures of the humerus, without any noticeable untoward effect on triceps strength and postoperative rehabilitation; hence, one can avoid iatrogenic fracture of the olecranon and its associated complications.

Keywords

• humerus
• intercondylar fracture
• trap