Ulus Travma Acil Cerrahi Derg. 2020; 26(4): 586-592 | DOI: 10.14744/tjtes.2019.69486

In intra-articular distal humeral fractures: Can combined medial-lateral approach gain better outcomes than olecranon osteotomy?

Libiao Wei¹, Haitao Xu², Zhiquan An^2
1Huadong Hospital Affiliated to Fudan University, Shanghai-China
²Department of Traumatic Orthopedics Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai-China

BACKGROUND: This research aimed to evaluate the functional outcomes of intra-articular distal humeral fractures treated through a combined medial-lateral approach and comparing with olecranon osteotomy simultaneously.
METHODS: In this study, 62 distal humeral fractures patients were assessed retrospectively. The olecranon osteotomy was used in 30 cases (14 males, 16 females) and combined medial-lateral in 32 cases (15 males, 17 females). The outcomes of function were assessed by the Mayo Elbow Performance Score (MEPS) and the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire score. The follow-up time was 15.4±3.5 months (range 10–24 months) for a combined medial-lateral group and 14.6±2.6 months (range 10–20 months) for olecranon osteotomy. Level of Evidence: Level, retrospective study.
RESULTS: The flexion–extension of elbows was 115.3°±16.1° in the combined medial-lateral group, and the olecranon osteotomy group was 110.1°±15.2°. A significant difference was observed between the two groups for flexion–extension of the elbows (p=0.041). Pronation–supination of the forearms had a significant difference (p=0.025) between the combined medial-lateral group (160.6°±7.2°) and the olecranon osteotomy group (154.1°±9.3°). Mean MEPS, DASH, excellent and good rate and complication rate for combined medial-lateral approaches were 88.6±6.9 points, 9.8±6.6 points, 90.6% and 9.4%, respectively. Significant differences were not noted between the two groups for mean MEPS, DASH scores and excellent and good rate (p=0.594, p=0.505, p=0.934, respectively) except complication rate (p=0.005).
CONCLUSION: The combined medial-lateral approach is successful approach in the treatment of intra-articular distal humeral fractures (especially type C1 and C2) that provides better outcomes for the motion of the elbow, bleeding volume in surgery and complications than olecranon osteotomy.

Keywords: Combined medial-lateral approach, complication; distal humerus; functional outcomes; olecranon osteotomy; surgical approach.

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Ýntraartiküler distal humerus kýrýklarýnda: Kombine mediolateral yaklaþým olekranon osteotomisinden daha iyi sonuçlar elde edilmesini saðlayabilir mi?

Libiao Wei¹, Haitao Xu², Zhiquan An^2
1Fudan Üniversitesi Huadong Hastanesi, Þangay-Çin
²Shanghai Jiao Tong Üniversitesi Altýncý Halk Hastanesi, Ortopedi ve Travmatoloji Anabilim Dalý, Þangay-Çin

AMAÇ: Araþtýrma, kombine mediolateral yaklaþýmla tedavi edilen intraartiküler distal humerus kýrýklarýnýn fonksiyonel sonuçlarýný deðerlendirmeyi ve eþ zamanlý olarak olekranon osteotomisi ile karþýlaþtýrmayý amaçlamaktadýr.
GEREÇ VE YÖNTEM: Altmýþ iki distal humerus kýrýðý geriye dönük olarak incelendi. Otuz olguda (14 erkek, 16 kadýn) olekranon osteotomisi ve 32 olguda kombine mediolateral (15 erkek, 17 kadýn) yaklaþým kullanýldý. Fonksiyonel sonuçlar Mayo Dirsek Performans Skoru (Mayo Elbow Performance Score: MEPS) ve Kol, Omuz ve El Sakatlýklarý (Disabilities of Arm, Shoulder and Hand: DASH) anket skoru ile deðerlendirildi. Takip süreleri kombine mediolateral yaklaþým grubu için 15.4±3.5 ay (10–24 ay) ve olekranon osteotomisi için ise 14.6±2.6 ay (10–20 ay) idi.
BULGULAR: Dirseklerin fleksiyon-ekstansiyonu kombine mediolateral grupta 115.3°±16.1° ve olekranon osteotomisi grubunda 110.1°±15.2° idi. Dirseklerin fleksiyon-ekstansiyonu açýsýndan iki grup arasýnda anlamlý bir fark gözlendi (p=0.041). Önkollarýn pronasyon-supinasyonu açýsýndan kombine mediolateral grup (160.6°±7.2°) ile olekranon osteotomisi grubu (154.1°±9.3°) arasýnda anlamlý bir fark gözlenmedi (p=0.025). Kombine mediolateral yaklaþýmlar için ortalama MEPS, DASH skorlarýna göre mükemmel -iyi sonuç puanlarý ve komplikasyon oranlarý sýrasýyla 88.6±6.9 puana karþýn 9.8±6.6 puan ve %90.6’ya karþýn %9.4 idi. Ýki grup arasýnda komplikasyon oraný (p=0.005) dýþýnda ortalama MEPS, DASH skorlarý ve mükemmel ve iyi oranlar (sýrasýyla p=0.594, p=0.505, p=0.934) arasýnda önemli farklýlýklar görülmemiþtir.
TARTIÞMA: Kombine mediolateral yaklaþým, intraartiküler distal humerus kýrýklarýnýn (özellikle tip C1 ve C2) tedavisinde dirsek hareketi, ameliyattaki kanama hacmi ve komplikasyonlar açýsýndan olekranon osteotomisine göre daha iyi sonuçlar veren baþarýlý bir yaklaþýmdýr.

Anahtar Kelimeler: Cerrahi yaklaþým, distal humerus; fonksiyonel sonuçlar; kombine mediolateral yaklaþým; komplikasyon; olekranon osteotomisi.

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