engleski

The new ulnar window triceps sparin approach for extraarticular distal humeral fractures

The principal objective of treating extraarticular distal humeral fractures is restoring alignment and achieving stable fixation aimed at facilitating early elbow range of motion, essential for a good functional outcome. It is often difficult to obtain rigid fixation in distal fractures of the humeral diaphysis without compromising the elbow. Alonso-Llames tricepssparing approach involves sub-periosteal elevation of the distal triceps off the posterior aspect of the humerus. This approach is applicable in treating fractures of the distal humerus by developing “windows” along the medial and lateral borders of the triceps without injuring the triceps aponeurosis and its insertion into the olecranon. In nine patients, who had extraarticular distal humeral fracture, named after the author who first described them as Holstein-Lewis fractures, I made triceps sparing approach through only one - ulnar window. As a first step, the ulnar nerve is isolated and protected with a vessel loop. Proximally, the ulnar nerve is followed along its course on the medial intermuscular septum, and the triceps muscle is mobilized radially extensively. In all cases I made perpendicular position of the plate. In all patients I found full and fast recovery of range of motions after 4 weeks from surgery, without sings of nerve injury. I have not found an article which describe these approach for treatment of extraarticular distal humeral fracture. For a definitive conclusion about the impact of the approach to the outcome of treatment we need to conduct randomized research of all anatomic approaches.

extraarticular ; distal humerus ; fractures ; stable fixation

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