Percent Articular Exposure of the Distal Humerus with Triceps Fascial Tongue Approach Compared to Olecranon Osteotomy
Nathan Winek, MD1; Aaron Rubinstein, MD2; Steven Regal, MD1
1Allegheny General Hospital, Pittsburgh, PA; 2Rutgers New Jersey Medical School, Newark, NJ
Introduction Distal humerus fractures are common and can be difficult to treat. No one approach to the distal humerus has been shown to be superior to another however the olecranon osteotomy remains the gold standard for complex, intra-articular fractures. Understanding the percent of articular exposure with approaches to the distal humerus is important for success. The goal of this study is to show the percent articular exposure of the triceps fascial tongue approach as compared to the olecranon osteotomy.
Materials & Methods Twelve fresh frozen cadavers were separated randomly into two groups of six. The first group of six specimens were allocated to the triceps fascial tongue approaches with the collaterals maintained and with the collaterals released off the ulna and elbow dislocated. The second group of six was allocated to the triceps fascial tongue approach while maintaining the collaterals followed by an olecranon osteotomy. The articular exposure was marked after performing each approach and the percent of articular exposure was quantified by utilizing 3D scanning. Standard deviations were calculated for each.
Results The average percent visualization of the distal humerus articular surface in the fascial tongue approach while maintaining the collaterals was 36% in the first cohort and 37% in the second cohort with a standard deviation of 5% in both cohorts. The average percent of distal humerus articular surface exposed in the fascial tongue approach with collaterals released off the ulna and elbow dislocated was 85.09% with standard deviation of 4%. The average percent of distal humerus articular surface exposed in the olecranon osteotomy group was 57.9% with a standard deviation of 5%.
Conclusion The triceps fascial tongue approach allows for visualization of about one third of the joint which may be adequate for many intra-articular distal humerus fractures. For added exposure of the articular surface, the collaterals may be elevated from the ulna and the elbow dislocated allowing for a substantial increase in percent of articular exposure compared to collateral retaining fascial tongue approach and the olecranon osteotomy.
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