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
| Autor: | Seong Hyun Kang, Jong Keon Oh, Do Hyun Yeo, Jae-Woo Cho, Won Tae Cho, Beom-Soo Kim, Eic Ju Lim, Seungyeob Sakong |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male musculoskeletal diseases Humeral Fractures medicine.medical_specialty Intra-Articular Fractures medicine.medical_treatment Operative Time Elbow Distal humerus Fracture Fixation Internal Young Adult 03 medical and health sciences 0302 clinical medicine Elbow Joint Fracture fixation Cadaver medicine Humans Orthopedics and Sports Medicine Reduction (orthopedic surgery) Aged Aged 80 and over 030222 orthopedics business.industry Trauma center 030229 sport sciences General Medicine Humerus Middle Aged Plastic Surgery Procedures musculoskeletal system Surgery Treatment Outcome medicine.anatomical_structure Cadaveric dissection Female Implant Radiology Elbow Injuries Cadaveric spasm business |
| Zdroj: | Journal of Shoulder and Elbow Surgery. 29:1554-1563 |
| ISSN: | 1058-2746 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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