Lateral epicondyle osteotomy approach for coronal shear fractures of the distal humerus: Report of three cases and review of the literature

Lateral epicondyle osteotomy approach vs. olecranon osteotomy approach: an anatomic study of cadavers

BACKGROUND

Exposure of the articular surface is the key to successful open reduction and internal fixation treatment for coronal shear fractures of the distal humerus. The olecranon osteotomy approach has previously been described as one of the most effective exposure approaches. Nevertheless, this approach cannot expose the anterior trochlea, and it is impossible to reduce and fix the capitellum under direct vision. The purpose of this study was to compare the exposure of the articular surface of the distal humerus between the lateral epicondyle osteotomy approach (group L) and the olecranon osteotomy approach (group O).

METHODS

Each approach was performed on 8 freshly frozen upper limbs of adult cadavers. After each approach was completed, a 0.5-mm Kirschner wire is inserted along the edge to mark the visible part of the articular surface. Then, the soft tissue of each elbow is removed, and a surface-scanning system is used to create a digital 3-dimensional model. The visible part of the articular surface obtained by each surgical approach was mapped and quantified using markers created by Kirschner wires.

RESULTS

The lateral epicondyle osteotomy approach and the olecranon osteotomy approach exposed 0.8 ± 0.0 and 0.6 ± 0.0 of the distal humeral articular surface (P < .001), 1.0 ± 0.0 and 0.3 ± 0.1 of the capitellum (P < .001), 0.6 ± 0.0 and 0.7 ± 0.0 of the trochlea (P < .001), 0.7 ± 0.0 and 0.5 ± 0.1 of the anterior trochlea (P < .001), and 0.5 ± 0.0 and 1.0 ± 0.0 of the posterior trochlea, respectively (P < .001).

CONCLUSION

Compared with the olecranon osteotomy approach, the lateral epicondyle osteotomy approach could more fully expose the total articular surface of the distal humerus, capitellum, and anterior trochlea, but the olecranon osteotomy approach could more fully expose the trochlea and posterior trochlea.

Capitellum and trochlea fractures. A systematic review of the literature

PURPOSE

To investigate the outcome of capitellum and trochlea fractures through a systematic review of the contemporary literature. The effect on the outcome, of the posterolateral column comminution and the surgical approach used for fixation, was also evaluated.

METHODS

PUBMED, SCOPUS and MENDELEY databases were searched for capitellum and trochlea fractures and a systematic review was conducted according to PRISMA guidelines. The minimum one year clinical outcome and the flexion extension arc of these fractures, as well as the risk of developing degenerative arthritis were evaluated. The studies included to the meta - analysis were assessed based on the Newcastle Ottawa score. A fixed effect model was performed to compare the outcome and range of motion among Dubberley type A and type B fractures as well as between the extended lateral approach and the posterior transolecranon approach which were performed for Dubberley type B fractures. Furthermore the relative risk of degenerative arthritis (DA) among type A and type B fractures was also estimated. Chi square test was used to test heterogenity among studies.

RESULTS

Ten nonrandomized case series were eligible to our inclusion criteria, including 76 patients in total. The fixed overall Mayo Elbow Performance Score (MEPS) and the Range of Motion (ROM) of the Dubberley type A fractures was 86 (95% C.I.: 85,1-86,9) and 124 0 (95% C.I.: 122 0-124 0) respectively. The fixed overall MEPS and ROM of the Dubberley type B fractures was 84 (95%C.I.: 79,9-88,1) and 122 0 (95% C.I.: 120 0-123 0) respectively. Significant heterogenity was found though between studies regarding MEPS of type B fractures. The fixed overall MEPS and ROM for fractures treated with an extended lateral approach was 89,4 (95% C.I.: 85,36-93,44) and 123 0 (120 0-126 0) respectively. The fixed overall MEPS and ROM for fractures treated with a posterior transolecranon approach was 68,75 (95% C.I.: 67,89-69,6) and 122 0 (114 0-130 0) respectively. The degenerative arthritis relative risk (RR) of type B compared to type A fractures was 3,91 (95% C.I.: 0,84-18,13).

CONCLUSION

There is no statistically significant difference among type A and type B fractures, in terms of outcome and ROM. The posterior transolecranon approach leads to a lower MEPS as opposed to the extended lateral approach. High quality studies comparing directly the outcome of type A and type B fractures are required, in order for safe conclusions to be extracted.

Coronal Shear Fractures of the Distal Humerus

Coronal shear fractures of the distal humerus are rare, frequently comminuted, and are without consensus for treatment. The aim of this paper is to review the current concepts on the diagnosis, classification, treatment options, surgical approaches, and complications of capitellar and trochlear fractures. Computed Tomography (CT) scans, along with the Dubberley classification, are extremely helpful in the decision-making process. Most of the fractures necessitate open reduction and internal fixation, although elbow arthroplasty is an option for comminuted fractures in the elderly low-demand patient. Stiffness is the most common complication after fixation, although reoperation is infrequent.