Treatment of AO Type C Fractures of the Distal Part of the Humerus through the Bryan-Morrey Triceps-Sparing Approach

Abstract

Several alternative approaches have been described to avoid the complications related to the olecranon osteotomy used to treat distal articular humerus fractures. The published experience with the triceps-sparing approach is scant. In this prospective study, a total of 12 patients with an articular humeral fracture were treated using this approach. At a mean followup of 1,7 years, the average range of motion was 112.8° (range from 85° to 135°); the elbow flexion averaged 125.5° (range from 112° to 135°) and the deficit of elbow extension 14.6° (range from 0° to 30°). All the elbows were stable. The Mayo Elbow Performance Score (MEPS) averaged 93.3 (range from 80 to 100). In the present series no failure of the triceps reattachment to the olecranon was found, and all the patients recalled returning to their previous daily life activities without impairment with a satisfactory MEPS. As a conclusion, the triceps-sparing approach can be considered for treating distal articular humerus fractures. We consider that three clinical settings can be more favorable to use this approach: those cases in which a total elbow prosthesis might be needed, cases of ipsilateral diaphyseal fracture, or presence of previous hardware in the olecranon.