Paratricepital Approach for Fixation of Distal Humerus Fractures in Adult – A Review of Thirty Cases

ABSTRACT

Background: Distal humerus fractures are most commonly managed by surgical approaches that disrupt the extensor mechanismof the elbow. Paratricepital approach for distal humerus fracture fixation has been done by orthogonal or parallel plate constructthat allows excellent healing of fracture, motion arc of elbow more than 100°, and maintains of extensor mechanism strength.Materials and Methods: Atotal of 30 cases of distal humerus fractures are fixed by paratricepital posterior approach. Bicolumnerfixation done by elevating and retracting the triceps of the distal humerus keeping triceps insertion undisturbed by orthogonalor parallel plate construct. Early active-assisted range of motion initiated within limits of pain. The age group was 15–60 years.Among them 21% was Type A fracture, 17% Type B fracture, 33% Type C1 fracture, and 29% Type C2 fracture. More than60% of cases have 1 year of follow-up. Radiograph and functional evaluation were done by mayo elbow performance score(MEPS), disability of arm, shoulder, and hand questionnaire.Results: All 30 fractures healed primarily. The median arc of elbow motion was 105° (range 70°–140°). Average MEPS was91 points (range 65–100) indicating excellent scores.Conclusion: Treatment of distal humerus fracture in adults by paratricepital posterior approach results in excellent healing, amean flexion extensor arc more than 100°, maintains of almost normal elbow extensor strength compared with the contralateralnormal elbow.