Clinical outcome of AO/OTA type C fracture of the distal humerus using the expanded paratricipital approach and cadaveric comparison of the exposure of the paratricipital and expanded paratricipital approaches to the distal humerus.
BACKGROUND
We investigated the overall clinical outcome of the expanded paratricipital approach in complex articular fractures of the distal humerus and the effect of lack of visualization in the surgical field. In addition, we performed a cadaveric study to investigate the expansion or limitation of articular access in the expanded paratricipital approach.


METHODS
Forty-one AO/OTA type 13C fracture cases treated using the expanded paratricipital approach at a single trauma center from 2013 to 2017 were enrolled in this study. We evaluated the overall clinical outcome and analyzed the effect of lack of visualization in the surgical field with the expanded paratricipital approach by comparing outcomes between 2 groups classified by the location of the main articular fracture (group 1, limited visualization; group 2, without limited visualization). The length of inaccessible and accessible articular segments were analyzed using 40 matched-pair elbows.


RESULTS
The average duration of follow-up was 15.1 months. All fractures (type C1 in 11 cases, type C2 in 21, and type C3 in 9) were radiologically healed at 3.2 months after surgery. No cases required additional surgery because of implant irritation. The average Mayo Elbow Performance Score was 90.5. The mean Disabilities of the Arm, Shoulder and Hand score was 18.5. Among the 41 cases, the limited visualization group (group 1, n = 21) had a longer surgical time and higher percentage of nonanatomic reduction than group 2. Although the expanded paratricipital approach allowed more articular exposure than the conventional approach, there was still a 20mm inaccessible articular segment (30% of transepicondylar width) in cadaveric dissection.


CONCLUSIONS
The expanded paratricipital approach can be used in type C1, type C2, and selective type C3 articular fractures of the distal humerus with favorable results. Relative to surgical times and achieving anatomic reduction, it is more successful in a fracture with a main articular fragment and with good visualization.
['Cho|Jae-Woo|JW|', 'Kim|Beom-Soo|BS|', 'Yeo|Do-Hyun|DH|', 'Kang|Seong Hyun|SH|', 'Lim|Eic Ju|EJ|', 'Sakong|Seungyeob|S|', 'Cho|Won-Tae|WT|', 'Oh|Jong-Keon|JK|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D002102:Cadaver D004551:Elbow Joint D005260:Female D005593:Fracture Fixation, Internal D006801:Humans D006810:Humeral Fractures D006811:Humerus D057072:Intra-Articular Fractures D008297:Male D008875:Middle Aged D061646:Operative Time D011871:Radiology D019651:Reconstructive Surgical Procedures D016896:Treatment Outcome D055815:Young Adult
outcome Distal humerus expanded paratricipital complex articular fracture fracture fixation surgical approach