The comparison of results of triceps-reflecting anconeus pedicle and olecranon osteotomy in the intra-articular fractures of the distal humerus

Objectives: Distal humerus fractures with articular involvements require surgical treatment. These fractures are used in different surgical approach and fixation method. In this study we evaluated the functional outcomes and factors that affect the results of patients treated with triseps-reflecting anconeus pedicle (TRAP) and olecranon osteotomy. Material And Method: Between January 2006 -November 2012 at Dicle University Faculty of Medicine, Department of Orthopaedics and Traumatology, due to distal humerus fractures with articular involvements of 36 patients were treated. Twenty one (%58.3) patients, TRAP (GroupI) and 15 (%41.7) patients, olecranon osteotomy (GroupII) was used as a surgical expansion method. In Group I, 11 were male and 10 were female and the mean age was 36.7. Group II, 8 male and 7 female and the average age was 34.4. According to AO classification in Group I 4 type C1, 8 type C2, 9 were type C3 fractures. In Group II, 1 type C1, 5 type C2, and 9 were type C3 fractures. In Group I 6, Group II 3 had open fractures.Average of 3.7 days in Group I and 3,0 days Group II were operated. In Group I, 7 were 90-90 paltting and 14 were parallel plating , In Group II, 3 were 90-90 paltting and 12 were parallel plating were used. All patients were started early rehabilitation. Functional results were evaluated with the Mayo elbow performance score and the DASH score. Results: The mean duration of follow were 38.4 months in Group I, 27,8 months in Group II. In Group I, mean DASH scores 15.4 (p>0.05) , mean elbow flexion-ekstansiyon range motion 109,0 degrees (p<0.05) were detected. In Group II, mean DASH scores 20,6, mean elbow flexion-ekstansiyon range motion 96,6 degrees were detected. According to Mayo Elbow Performance Scorıng system, the results in Group I very good in 10, good in 8, mean in 2, and poor in 1 paitents, in Group II very good in 5, good in 7, mean in 2, and poor in 1 paitents. Patients treated with TRAP method were found to have better results. One of the parameters that affect the type of the fracture functional results and after injury early surgical applications were received better results (p<0.05). Age and gender did not influence the functional results. Conclusion: Distal humerus fractures with articular involvements should be operated in the early period. Surgical approach with TRAP provided better functional outcomes than olecranon osteotomy approach. Surgical fixation must be stable enough to allow early rehabilitation and patients should be started early rehabilitation. Keywords: distal humerus; TRAP; olecranon osteotomy;internal fixation