The triceps–flexor carpi ulnaris (TRIFCU) approach to the elbow

INTRODUCTION Intra-articular fractures of the distal humerus frequently require internal fixation. Several approaches have been described, with the posterior approaches being most common. We present a new approach to the distal humerus via the lateral border of the triceps muscle. PATIENTS AND METHODS The senior author has used this technique for fixation of intra-articular fractures of the distal humerus in 12 patients. RESULTS The approach is equally useful for intra- and extra-articular fractures. No cases of postoperative ulna nerve neuropraxia have been encountered. There have been no postoperative wound complications. The exposure has allowed sufficient access to allow anatomically contoured plates to be easily applied to both sides of the distal humerus with confirmation of intra-articular fracture reduction. CONCLUSIONS The approach has the advantages of leaving the muscular bed of the ulna nerve undisturbed, whilst still providing excellent exposure of the distal humerus. The triceps mechanism is not divided or split allowing rapid recovery of extensor function. Additionally, because of the natural carrying angle of the elbow, repositioning of the reflected triceps aponeurosis is easy.

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Treatment of Distal Humerus Articular Fracture with Pin-and-Plate Technique

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s242483552050037x ◽

2020 ◽

Vol 25 (03) ◽

pp. 332-339

Author(s):

Abbas Abdoli ◽

Amir Reza Farhoud ◽

Reza Shahryar Kamrani

Keyword(s):

Plate Fixation ◽

Distal Humerus ◽

Kirschner Wires ◽

Stable Fixation ◽

Articular Fracture ◽

Plate Technique ◽

Articular Fractures ◽

Flexion Extension ◽

The Mean

Background: Distal Humerus Articular Fracture (classified by Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association as 13-B3) is an uncommon fracture with significant complications. We report results of 14 patients treated by open reduction and pin-and-plate fixation technique. Methods: In this retrospective study, we applied pin-and-plate fixation to 14 distal humerus articular fractures, in which screw fixation alone was inefficient or inadequate to provide stable fixation. After anatomical reduction of articular fragments, multiple Kirschner wires were inserted through the fragments. To prevent migration of Kirschner wires a small plate was placed proximally on the bent end of the pins. Results: The average age of 14 patients (8 males and 6 females) was 36.4 years (range: 16–57) and the mean follow up period was 43 months (range: 12–80). At last follow up the average quick Disabilities of the Arm, Shoulder and Hand score was 18.9 (range: 2.3–42.5) and the mean points for Mayo Elbow Performance Index was 75.3 (range: 50–100). Mean final arc of flexion-extension was 97° (range: 40–131). Conclusions: Distal humerus articular fracture is sometimes difficult to fix with conventional methods. We used pin-and-plate technique that could make a stable fixation and allow early range of motion with acceptable results.

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Outcomes of Modalities of Treatment of Intra Articular Fracture of Distal Humerus in Adults

International Journal of Scientific Research ◽

10.15373/22778179/july2013/106 ◽

2012 ◽

Vol 2 (7) ◽

pp. 316-317

Author(s):

DR DIPAK A SHAH ◽

◽

DR MITUL MISTRY ◽

DR UMANG AGRAWAL

Keyword(s):

Distal Humerus ◽

Articular Fracture

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Open reduction and internal fixation compared with primary total elbow arthroplasty for displaced intra-articular fractures of the distal humerus in the elderly

Current Orthopaedic Practice ◽

10.1097/bco.0b013e31823cd605 ◽

2012 ◽

Vol 23 (1) ◽

pp. 59-62 ◽

Cited By ~ 2

Author(s):

Cyril Mauffrey ◽

Njale Baraza ◽

Charlie Lewis ◽

David Seligson

Keyword(s):

Internal Fixation ◽

Open Reduction ◽

The Elderly ◽

Distal Humerus ◽

Total Elbow Arthroplasty ◽

Elbow Arthroplasty ◽

Articular Fractures

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Ectopic Ossification of the Triceps Muscle After Application of Bone Morphogenetic Protein-7 to the Distal Humerus for Recalcitrant Nonunion: A Case Report

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2007.03.001 ◽

2007 ◽

Vol 32 (5) ◽

pp. 647-650 ◽

Cited By ~ 24

Author(s):

Robert W. Wysocki ◽

Mark S. Cohen

Keyword(s):

Case Report ◽

Bone Morphogenetic Protein ◽

Distal Humerus ◽

Ectopic Ossification ◽

Bone Morphogenetic Protein 7 ◽

Triceps Muscle ◽

Morphogenetic Protein

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THE TREATMENT OF EXTRA- AND INTRA-ARTICULAR FRACTURES THE DISTAL HUMERUS

Traumatology and Orthopedics of Russia ◽

10.21823/2311-2905-2010-0-3-144-151 ◽

2010 ◽

Vol 16 (3) ◽

pp. 96-102

Author(s):

V. V. Klyuchevsky ◽

Hassan Ben El Hafi

Keyword(s):

Soft Tissues ◽

Functional Results ◽

Distal Humerus ◽

Distal Segment ◽

Rigid Fixation ◽

Performance Score ◽

Mayo Elbow Performance Score ◽

Articular Fractures ◽

Active Mobilization ◽

Violent Acts

From 2005 to 2009 we treated 112 patients with fractures of distal segment of the humerus, 83 (74,10%) of them were injured when falling from the height of its own growth, 8 (7,14%) - in an accident, 6 (5,35%) - a fall from a height, 13 (11,6%) - in sports, and two - as a result of violent acts. In 97 (87%) cases the fractures were closed, in 15 (13%) - open. 19 patients were treated conservatively and 93 - operatively. Functional results were evaluated using the Mayo elbow performance score (MEPS) in 78,37% of patients. Results of the conservative method: excellent and good - 46,66%, and in all patients with type A without displacement - in 100%. The fair results - in 33% and the poor in 20% - with type В and C. The results of operative treatment: excellent and good - 90,41%, the fair results - in 9,58%, no poor results. Initial prevent the oedema and bleeding into joints and soft tissues, adequate rigid fixation of fractures with the maximal restoration of the elbow joint congruent without additional immobilization and early active mobilization is essential to prevent the elbow stiffness and achieve a good outcomes.

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Clinical efficacy of treating the first metacarpal base fracture by closed reduction and percutaneous parallel K-wire interlocking fixation

10.21203/rs.3.rs-447849/v1 ◽

2021 ◽

Author(s):

Wu Wang ◽

Min Zeng ◽

Junxiao Yang ◽

Long Wang ◽

Jie Xie ◽

...

Keyword(s):

Clinical Efficacy ◽

Closed Reduction ◽

Fracture Group ◽

Articular Fracture ◽

Articular Fractures ◽

Injured Side ◽

Uninjured Side ◽

Flexion Extension ◽

The Mean

Abstract Objective: To explore the clinical efficacy of treating a first metacarpal base fracture by closed reduction and percutaneous parallel K-wire interlocking fixation between the first and second metacarpals.Methods: Twenty patients treated by the above technique from October 2015 to December 2018 at our institution were retrospectively reviewed. The patients’ average age was 36 years (range, 16–61 years). Eleven patients were extra-articular fractures and nine were intra-articular fractures. The mean follow-up period was 12 months (range, 10–18 months). At the final follow-up, the functional recovery of the injured hand was assessed and compared with that of the uninjured hand.Results: All patients recovered well with no complications. In the extra-articular fracture group, the mean hand grip strength, pinch strength, and Kapandji score were 43.4 ± 7.0 kg, 9.1 ± 1.4 kg, and 9.5 ± 0.7 on the injured side and 41.7 ±6.8 kg, 8.7 ± 0.8 kg, and 9.7 ± 0.5 on the uninjured side, respectively, with no significant differences. In the intra-articular fracture group, the above indexes were 43.0 ± 6.5 kg, 9.0 ± 1.1 kg, and 9.3 ± 0.7 on the injured side and 42.1 ± 6.6 kg, 8.6 ± 1.1 kg, and 9.7 ± 0.5 on the uninjured side, respectively, also with no significant differences. The abduction and flexion-extension arc of the thumb on the injured hand were lower than those on the uninjured hand in both the extra-articular and intra-articular fracture groups, but the patients felt clinically well with respect to daily activities and strength.Conclusion: The percutaneous parallel K-wire and the interlocking fixation technique is simple, effective, and economic for first metacarpal base fractures.

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Elbow Dislocation and Articular Fracture of the Distal Humerus

Shoulder & Elbow ◽

10.1111/j.1758-5740.2010.00049.x ◽

2010 ◽

Vol 2 (2) ◽

pp. 111-117 ◽

Cited By ~ 1

Author(s):

Thierry G. Guitton ◽

Andrew D. Duckworth ◽

Margaret M. Mcqueen ◽

Peter Kloen ◽

David Ring

Keyword(s):

Medial Collateral Ligament ◽

Articular Surface ◽

Present Report ◽

Elbow Dislocation ◽

Distal Humerus ◽

Fracture Dislocation ◽

Elbow Fracture ◽

Collateral Ligament ◽

Articular Fracture

Background The present report describes subluxation and dislocation of the elbow with articular fracture of the distal humerus and injury to the medial collateral ligament, a type of elbow fracture-dislocation about which little is available in the literature. Methods Twenty-two patients with subluxation or dislocation of the elbow (with injury to the medial collateral ligament) and a fracture of the distal humerus articular surface (capitellum/trochlea) were identified. Seventeen patients had a minimum of 12 months follow-up and eight patients returned for a long-term follow-up at a median of 36 months (range 12 months to 154 months) after injury. Results Nine patients had one or more subsequent surgeries. Seven patients had surgery to address complications and two had a planned implant removal. The final median arc of elbow flexion was 120° (range 100° to 145°) and the median arc of forearm rotation was 175° (range 150° to 180°). The median Broberg and Morrey score was 88 points (range 63 points to 100 points) and the median Disabilities of the Arm Shoulder and Hand score was 9 points (range 1 point to 43 points). Discussion Some elbow dislocations and subluxations are associated with osteochondral fractures of the distal humeral articular surface.

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Coronal shear fractures of the distal humerus: Current concepts and surgical techniques

Shoulder & Elbow ◽

10.1177/1758573219826529 ◽

2019 ◽

Vol 12 (2) ◽

pp. 124-135 ◽

Cited By ~ 1

Author(s):

Jay J Watson ◽

Simon Bellringer ◽

Joideep Phadnis

Keyword(s):

Clinical Experience ◽

Surgical Techniques ◽

Distal Humerus ◽

Humeral Fractures ◽

Articular Fractures ◽

Distal Humeral Fractures

Coronal shear fractures of the distal humerus are a unique subset of distal humeral fractures which entail partial or complete articular fractures of the distal humerus without involvement of the columns. The very distal nature of these fragments, their small size and propensity for comminution render them challenging to treat surgically. The purpose of this article is to describe the classification, outcomes and surgical techniques currently used for the treatment of these fractures using the available literature and authors' clinical experience.

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