Extensor mechanism sparing para tricipital posterior approach to the distal humeral shaft fractures: An alternative approach for fracture treatment

Abstract

Introduction: Generally Anterolateral and posterior surgical approaches are most commonly used approaches for fractures of middle thirds and distal third of the humerus. In posterior approach, usually splitting of triceps is done for exploring humerus. We studied an alternative, triceps reflecting para tricipital approach which spares the extensor mechanism. We are using it for the lower third extra articular humerus fracture to achieve good exposure of humerus so as to avoid muscle splitting and gaining the early ROM range of motion [1, 2] . Materials and Methods: We studied 15 skeletally mature distal humerus fractures at our center treated by Triceps sparing approach with minimum follow up for a period of 6 months. They were functionally assessed with MAYO score [3] , measurements of ROM and radiological union. Mean duration of follow up was 10 months with range from 6-14 months. Results: The average Mayo score was 95 indicating an excellent performance with a mean functional ROM 132 degree with range from 120-140 degree. Only 1 patient had complication of infection which was not related to approach. Conclusion: The triceps reflecting approach (TRA) is a valuable option for ORIF in distal shaft humerus fractures. The extensor mechanism-sparing Paratricipital approach is an invaluable approach for fixation of lower third fractures of the humerus without negative effects on triceps strength. The clinical outcome parameters of our series revealed excellent maintenance of strength compared to the contralateral side. This approach gives us liberty to mobilize elbow joint actively as well passively and also avoids complications related to triceps adhesions.