Superior outcome with anterolateral approach in treating O'Driscoll type II ulnar coronoid process fractures: a retrospective analysis.

Abstract

Background: O'Driscoll type II fractures of the ulnar coronoid process present significant challenges in orthopedic surgery, requiring precise techniques for optimal recovery.

Objective: To compare the efficacy of anterolateral approach versus medial approach in treating O'Driscoll type II fractures of the ulnar coronoid process in the elbow.

Methods: This retrospective study involved 226 patients with O'Driscoll type II fractures treated at the Fourth People's Hospital of Hengshui between January 2021 and December 2023. Patients were divided into two groups according to the type of surgical approach: lateral (n = 121) and medial (n = 105). Exclusion criteria included pathologic fractures, mental disorders, and open fractures. Surgical procedures were standardized for both groups, with the lateral group receiving a curved S-shaped incision and the medial group receiving a 5.0 cm anterior-medial incision. Surgical and recovery outcomes included elbow joint range of motion, Visual Analog Scale (VAS) scores, Mayo Elbow Performance Score (MEPS), incidence of postoperative complications, and SF-36 health-related quality of life scores over a six-month follow-up.

Results: Preoperative characteristics were comparable between groups (P > 0.05). The lateral approach significantly improved postoperative elbow flexion and rotation at 1, 3, and 6 months (P < 0.05). Surgical-related indicators favored the lateral approach, which demonstrated reduced incision length, shorter surgery duration, and lower intraoperative blood loss (P < 0.05). No significant differences in VAS scores were noted between groups throughout the follow-up. The lateral group achieved higher MEPS scores at six months postoperative (P < 0.05) and a higher excellent/good rate (P < 0.05). Additionally, the lateral approach resulted in significantly fewer complications (P < 0.05). Short-Form 36 Health Survey Questionnaire (SF-36) scores showed no significant difference in quality of life between groups at six months postoperative (P > 0.05).

Conclusion: The lateral surgical approach for O'Driscoll type II fractures of the ulnar coronoid process offers superior surgical and functional outcomes. It provides a better range of motion, fewer complications, and improved joint performance scores compared to the medial approach, though both methods yield comparable pain relief and quality of life. Therefore, the lateral approach is recommended to enhance postoperative recovery.