Ulus Travma Acil Cerrahi Derg. 2016; 22(1): 58-65 | DOI: 10.5505/tjtes.2015.42948

The comparison of triceps-reflecting anconeus pedicle and olecranon osteotomy approaches in the treatment of intercondylar fractures of the humerus

Ýbrahim Azboy¹, Mehmet Bulut¹, Cahit Ancar¹, Abdullah Demirtaþ², Emin Özkul¹, Mehmet Gem¹, Hilmi Karadeniz³, Hüseyin Arslan^1
1Dicle University Medical Faculty, Department Of Orthopaedics And Traumotology, Diyarbakýr
²Göztepe Education and Training Hospital, Departnet of Orthopaedics and Traumatology, Istanbul
³Bahçelievler Medikal Park Hospital, Department Of Orthopaedics And Traumotology, Ýstanbul

BACKGROUND: This study aimed to evaluate the functional outcomes of patients with intra-articular distal humerus fractures treated with triceps-reflecting anconeus pedicle (TRAP) and olecranon osteotomy.
METHODS: Forty patients with intra-articular distal humerus fractures were retrospectively analyzed. TRAP approach was used in 22 patients (12 males, 10 females; mean age 37.8 years, range 17-70), and olecranon osteotomy in 18 patients (11 males, 7 females; mean age 35.4 years, range 18–62). Fractures were classified using the AO/ASIF classification. Functional results were evaluated with the Mayo elbow performance score (MEPS) and the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire score.
RESULTS: The overall mean arc of elbow motion was 108° (range 70°–140°) in the TRAP group, whereas that of the olecranon osteotomy group was 98° (range 70°–115°). A significant difference was observed between the two groups in terms of overall mean arc of elbow motion (p=0.038). There were no significant differences noted between the two groups in terms of mean MEPS and DASH scores (p=0.412, p=201, respectively). The overall complication rate was 27.2% in the TRAP group and 55% in the olecranon osteotomy group.
CONCLUSION: TRAP is a succesful approach in the treatmet of intra-articular distal humerus fractures that provides better arc of elbow motion, reduces complications and reoperation rates.

Keywords: Distal humerus, internal fixation, intra-articular fracture, olecranon osteotomy; TRAP.

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Ýnterkondiler humerus kýrýklarýnýn tedavisinde triseps reflekting pedikül ve olekranon osteotomisi yaklaþýmlarýnýn karþýlaþtýrýlmasý

Ýbrahim Azboy¹, Mehmet Bulut¹, Cahit Ancar¹, Abdullah Demirtaþ², Emin Özkul¹, Mehmet Gem¹, Hilmi Karadeniz³, Hüseyin Arslan^1
1Dicle Üniversitesi Týp Fakültesi Ortopedi Ve Travmatoloji Ana Bilim Dalý, Diyarbakýr
²S.B. Göztepe Eðitim ve Araþtýrma Hastanesi Ortopedi ve Travmatoloji Kliniði, Ýstanbul
³Bahçelievler Medikal Park Hastanesi, Ortopedi Ve Travmayoloji Kliniði, Ýstanbul

AMAÇ: Eklem içi humerus alt uç kýrýklarýnýn tedavisinde triseps-reflekting ankoneus pedikül (TRAP) ve olekranon osteotomisi yöntemlerinin fonksiyonel sonuçlarý karþýlaþtýrýldý.
GEREÇ VE YÖNTEM: Eklemi içi humerus kýrýðý olan 40 hasta geriye dönük olarak incelendi. Bunlardan 22 hastaya (12 erkek, 10 kadýn; ortalama yaþ 37.8 yýl daðýlým 17–70) TRAP, 18 hastaya (11 erkek, 7 kadýn; ortalama yaþ 35.4 yýl daðýlým 18–62) olekranon osteotomisi uygulandý. Kýrýk sýnýflamasý AO/ASIF sýnýflamasýna göre yapýldý. Fonksiyonel sonuçlar Mayo dirsek performans skoru ve Kol, Omuz ve El Engellilik (DASH) skoru ile deðerlendirildi.
BULGULAR: Triseps-reflekting ankoneus pedikül grubunda dirsek eklem hareket açýklýðý ortalama 108° (daðýlým 40°–140°) iken olekranon osteotomisi grubunda ortalama 98° (daðýlým 70°–115°) bulundu. Eklem hareket açýklýðý bakýmýndan iki grup arasýnda istatiksel olarak anlamlý fark bulundu (p=0.038). Her iki grup arasýnda DASH ve MEPS puaný bakýndan istatiksel olarak anlamlý fark saptanmadý (p=0.412, p=201, sýrasýyla). Komplikasyon oranlarý TRAP grubunda %27.2 iken olekranon osteotomisi grubunda %55 bulundu.
TARTIÞMA: Triseps-reflekting ankoneus pedikül yöntemi, olekranon osteotomisine göre dirsek eklem hareket açýklýðýný saðlamada daha baþarýlýdýr. Ayrýca TRAP yöntemi komplikasyon oranlarýný ve yeniden ameliyat gereksinimini azaltmaktadýr.

Anahtar Kelimeler: Eklemiçi kýrýk, humerus alt uç, internal tespit, TRAP; olekranon osteotomisi.

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