Outcome following olecranon osteotomy versus paratricipital approach for complex intra-articular (AO 13-C) fracture of distal humerus: a prospective comparative study

Background: The paratricipital approach is a relatively new approach in a complex intra-articular fracture of distal humerus (AO13-C). The aim of this study was to ascertain this approach compared with the olecranon osteotomy approach. Also, we aimed to investigate whether advancing age and surgical delay yield a poor outcome.

Materials and methods: Between 2011 and 2015, 51 adult patients with closed AO 13-C-type fractures were included in the study and divided into 2 groups, that is, paratricipital approach (PT) group and olecranon osteotomy (OO) group. Patients were treated by 2 senior trauma surgeons. They were prospectively analyzed for outcome and complications. Mayo elbow performance score (MEPS) was used to evaluate the outcome.

Results: Of the total 51 patients (mean age, 41.6 years), 27 patients were in the PT group and 24 in the OO group. There was no difference in arc of motion (P = .513) and MEPS (P = .127) as well as complication rate (χ² statistic = 0.36, P = .54). However, specifically in the type C3 fracture, the PT group had a poor outcome for arc of motion (P = .002) and MEPS (P = .019) compared with the OO group. Also, age and surgical delay had a weak, negative correlation with arc of motion and MEPS. The association between age and surgical delay against arc of motion was statistically significant (P = .005 and .01, respectively).

Conclusions: The PT approach and the OO approach can be used alternatively for AO 13-C1 and -C2 fractures with similar outcomes. However, in type C3, the PT approach yields a poor outcome in comparison with the OO approach.