Bilateral separation approach of triceps through posterior median incision versus ulnar olec-ranon osteotomy approach in the treatment of humeral intercondylar fractures

Chen Daozhen; Zhao Zhijian; Xu Jisheng

doi:10.3969/j.issn.1009-4237.2024.04.010

Abstract：Objective To compare the clinical efficacy between ulnar olecranon osteotomy approach and bilateral separation approach of triceps through posterior median incision in the treatment of humeral intercondylar fractures.Methods Clinical data of 98 patients with humeral intercondylar fractures who were admitted to Shan-gqiu First People's Hospital from Mar.2019 to Mar.2020 were retrospectively analyzed.There were 57 males and 41 females aged 24-78(mean 42.8)years.AO/OTA classification revealed 20 cases of type C1,51 type C2 and 27 type C3,with 13 due to ground-level falls,46 to road traffic accidents,and 39 to falls from height.Patients were di-vided into Group A,in which bilateral separation approach of triceps was conducted(n=50),and Group B,in which ulnar olecranon osteotomy approach was conducted(n=48).The surgery-related indicators,postoperative recovery indicators,Mayo elbow performance score(MEPS),and incidence of complications were compared between two groups.Results Group A showed more intraoperative bleeding(mL,195.0±28.9 vs.158.8±19.1),and longer operation time(min,129.4±35.4 vs.106.1±22.2)and length of hospital stay(d,9.8±2.0 vs.7.4±2.5),all with significant difference compared with Group B(P＜0.001).The fracture healing time,joint flexion and extension range of motion(ROM)and elbow joint rotational ROM showed no significant difference(P＞0.05).The MEPS was much higher in Group A than in Group B at 1 month after surgery(54.1±9.1 vs.47.1±9.1,P＜0.001);after that,the differences were insignificant(P＞0.05 at 3,6 and 12 months after surgery).The incidence of complications re-vealed no significant differences either(18.0％vs.16.7％,P＞0.05).Conclusion Both the investigated approa-ches show good clinical effects in the treatment of humeral intercondylar fractures,with well-recovered elbow joint function.Moreover,the bilateral separation approach of triceps through posterior median incision(Group A),though can achieve an earlier functional recovery,is more technique-demanding with longer operation time and more intraop-erative blood loss and thus is unsuitable for physically weak patients.Individualized surgical plans should be made based on the patient's condition.