There are several options when treating a distal humerus fracture, and there is debate about which strategy is best. The results of the triceps tongue (TT) approach for osteosynthesis of distal humerus fractures in AO 13-A, B, and C are shown in this paper. Researchers assessed TT procedure stacks against the olecranon osteotomy (OO) approach. Patients with distal humerus fractures treated with open reduction and internal fixation (ORIF) were studied retrospectively using either a TT or OO method between 2007 and 2019 at two different institutions. Based on age, sex, and fracture characteristics, they matched TT patients with AO13-C fractures 1:1 to OO patients. Investigators compared surgery time, intraoperative blood loss, elbow motion, fracture union, complications, and DASH (Disabilities of the Arm, Shoulder, and Hand) scores.
A total of 28 patients were evaluated using the TT method, with 15 patients in each of the matched TT and OO cohorts. When compared to the OO group, the TT group lost less blood (119.3 mL versus 268.5 mL, P=.03), had greater maximal flexion (126° versus 116°, P=.03), and had a bigger flexion-extension arc (108° versus 93°, P=.05). In the OO group, 27% of patients reported olecranon osteotomy-related problems, and OO patients had greater postoperative ulnar nerve neuritis (33% versus 0%, p=.04). DASH scores (P=.08), operation time (P=0.2), the total number of patients with 1+ problems (P=0.5), difficulties with the union (P=0.7), and the number of patients requiring revision surgery (P=0.7) all remained unchanged. The TT method is a safe and successful option for the treatment of distal humerus fractures. When comparing the TT technique to the OO approach for AO 13-C fractures, the study team discovered that the TT approach had improved functional results, increased range of motion, reduced intraoperative blood loss, and caused less postoperative ulnar nerve neuritis. It enables optimal articular surface visualization, reduces difficulties associated with osteotomies, and facilitates conversion to total elbow arthroplasty. The triceps tongue technique should be a safe and reliable first-line treatment for intraarticular distal humerus fractures.