Distal Humerus Fracture Fixation: The Paratricipital approach is a good option resulting in high union rates and low rates of Heterotopic Ossification

Presenter’s name (Last, First): Gupta, Sai Sumana

Qualifications: BMed/MD

Affiliations: John Hunter Hospital (Hunter New England Local Health District), Newcastle, Australia

Other authors:
Kabilan Thurairajah/MBBS/JHH,

SarahWarby/Melbourne Shoulder Group/La Trobe University

Benjamin East/MBBS, FRACS/JHH

Email: sumanagupta94@gmail.com

Background / Introduction:
Distal humerus fractures can be fixed utilising a variety of surgical approaches. A complex articular surface with minimal surrounding bone stock makes exposure and fixation of these fractures challenging. Common concerns for the treating clinician include fracture visualisation, articular surface reduction, achieving adequate stability, bony union, and post-operative range of motion. We report outcomes of a series of 23 distal humerus fractures (AO types A2,A3, B1, B3, C1, C2, C3).

Patients / Methods:
A retrospective analysis of 23 patients was performed. Patients aged between 16 and 81 years requiring surgery for acute distal humerus fracture or malunion of previous distal humerus fracture from two surgeons were included. Patients requiring elbow arthroplasty or who were unable to complete the Patient Reported Elbow Evaluation (PREE) score were excluded. 17 patients underwent surgery with a paratricipital approach, and 6 patients underwent an olecranon osteotomy. All patients received Medartis periarticular plating. The primary outcome was fracture union. Secondary outcomes included need for revision surgery, Patient Reported Elbow Evaluation, Global Rating of Change (GRC) and satisfaction of treatment and outcome scores. Ethics approval was obtained for the local medical ethics committee (Hunter New England Local Health District Research Office).

Twenty three patients were included in the analysis. All patients progressed to fracture union, with no infection. Four patients required revision surgery: 1 for lateral escape requiring revision fixation, 2 patients for removal of prominent screw and 1 patient for ulnar nerve transposition after developing ulnar nerve entrapment. One patient developed significant heterotrophic ossification post-operatively. Twenty-one patients returned PREE scores and two patients could not complete PREE scores. The mean total PREE for the paratricipital approach and olecranon osteotomy approach was 23.06 and 42.8 respectively. Mean sub-scores respectively for paratricipita lapproach and olecranon osteotomy approach respectively were pain (7.9 SD 9.1) and (16.8 SD 10.7),function (9.5 SD 18.3) and (15.8 SD 12.5) and usual activity (5.7 SD 10.0) and (10.2 SD 6.0). GRC median 4.0 (25th percentile 3, 75th percentile 5). Satisfaction of outcome median 10 (25th percentile 8,75th percentile 10) and satisfaction of care median 10(25th percentile 8.75, 75th percentile 10).

The series was not adequately powered to compare outcomes of the paratricipital approach versus an olecranon osteotomy. Both approaches with Medartis periarticular plating resulted in fracture union in all patients. Overall, there was a low complication rate and a high union rate. We can conclude that this series shows good outcomes of union and function in patients with fracture patterns of varying complexity when a paratricipital approach was used. A low rate of heterotrophic ossification was encountered in this cohort who had early active range of motion following fixation.


Level of Evidence & Study type: III

Declarations of Conflict: No conflicts of interest