A true triceps-splitting approach for treatment of distal humerus fractures: a preliminary report

BACKGROUND: The treatment of distal humerus fractures has traditionally been performed via a posterior approach and an olecranon osteotomy. The article reports the authors' clinical experience using a triceps-splitting approach for a consecutive series of patients with distal humerus fractures. METHODS: A consecutive series of 37 patients with 39 distal humerus fractures were treated with a triceps-splitting approach. All the fractures were managed with two-column fixation. RESULTS: A total of 33 patients (34 fractures) were available for follow-up evaluation over an average of 26 months (range, 13-48 months). There were five type A and 29 type C fractures. Five of the fractures were grade 1 open. There were three elbows with clinically asymptomatic valgus instability (<5 degrees at 30 degrees flexion) and one elbow with symptomatic varus instability. There was one case of heterotopic ossification, limiting motion; one transient ulnar nerve palsy; one severe infection requiring resection arthroplasty; and five nonunions. Four of the five nonunions involved patients older than 65 years. CONCLUSIONS: The use of a triceps-splitting approach to gain access to the distal humerus provided adequate exposure and had an acceptable complication rate. In addition to allowing for distal humerus reconstruction, it avoided the reported complications of olecranon osteotomy and is easily extensile if required.