A combined paratricipital and triceps-splitting approach for distal humeral metaphyseal-diaphyseal fractures in adults.

BACKGROUND: Distal metaphyseal-diaphyseal fractures of the hume-rus can be challenging. The success lies in achieving a stable fixation that could allow early functional recovery. Our aim is to combine dif-ferent approaches already reported, to obtain an ideal surgical strategy for treating these fracture patterns. METHODS: In this retrospective study, we present the clinical outco-me of a 12-patient cohort in which we used a combined paratricipital and triceps-splitting approach to the distal humerus. The mean age of the group was 50 years (range 17 - 88). Clinical and radiographic evaluation was performed at 1, 3, 6, and 12 months after surgery and thereafter, depending on the necessity of a further control. Patients' range of motion (ROM) of the elbow was reported, and functional outcome was assessed using the Mayo Elbow Performance Index (MEPI).The minimum follow-up was fixed at 12 months. RESULTS: Union was achieved in all fractures. After a median follow-up of 15.7 months (range 12-21), none of the patients complained of any limitation in daily activities. The ROM at the last follow-up was complete in eight patients. Instead, three patients had ROM limitations, but none of them mentioned limitations in the activities of daily living. We observed a single iatrogenic radial nerve palsy undergoing a full functional recovery at the final follow-up. No further complications occurred. CONCLUSION: We believe that the here presented modified approach could represent a solution that meets the modern demands for both ro-bust fixation and early mobilization, with minimal soft tissues damage around distal humeral fractures.