| Objective:To explore and compare the clinical outcomes of the extensile lateral approach and the triceps-reflecting approach(Bryan-Morrey approach)in the treatment of Dubberley-B type coronal shear fractures of the distal humerus.Methods:Retrospectively analyzed of 16 patients with Dubberley-B type coronal shear fractures of the distal humerus who were surgically treated by the same group of surgeons of the orthopedists in our hospital from October 2019 to March 2022.According to the surgical approach,divided these patients into two groups(Group A and Group B).Patients in group A were treated by the extensile lateral surgical approach,with a total of 9 cases,including 6 females and 3 males,aged 26-61 years,with an average of 43.22±13.20 years;Patients in group B were treated by the posterior Triceps-reflecting surgical approach,with a total of 7 cases,including 5 females and 2males,aged 28-63 years,with an average of 43.43±12.63 years.Patients in both groups received complete preoperative and postoperative X-ray and CT scanning and 3D reconstruction of the elbow joint.The surgical time,the fracture healing time after operation,elbow joint stability,elbow mobility and Mayo Elbow Performance Score(MEPS)were compared between the two groups.Results:In the follow-up of patients in both groups,postoperative incision healing was achieved at stage I in both groups,and bony healing of the fracture was achieved at the last follow-up;no complications such as non-union or malunion of the fracture,instability of the elbow joint,avascular necrosis of the humeral head and stiffness of the elbow joint were observed in all patients.The postoperative follow-up time of group A range from 12 to 18 months,with an average of 14.33 ± 1.76 months.The average operative time was 105.89 ±8.31 minutes.The average postoperative fracture healing time was 12.89±1.54 weeks.The average postoperative range of motion of the elbow was 125.22±6.63° in flexion and extension and 154.33±7.91° in rotation,the average MEPS score was 91.00 ± 4.82.According to the Mayo elbow score,7 cases were excellent and 2 cases were good,the excellent ratio in group A was 100%.The patients in group B were followed up from 10 to 17 months,with an average of 13.43 ± 2.06 months.The average operative time was 128.29 ± 7.63 minutes.The average postoperative fracture healing time was 12.86±1.35 weeks.The average postoperative range of motion of the elbow joint was 111.86±11.36° in flexion and extension and143.57±6.63° in rotation,the average MEPS score was 81.86±6.62.According to the Mayo elbow score,1 case was excellent,5 cases were good and 1 case was acceptable,the excellent ratio in group B was 85.71%;one of the patients developed heterotopic ossification of the elbow joint,which did not progress after early intervention.There was a significant difference between the two groups in terms of operative time,elbow mobility and Mayo Elbow Performance Score(MEPS),and the difference was statistically significant(P < 0.05);On the contrary,there was no significant difference in the time of fracture healing after surgery between the two groups,and the difference between the groups was not statistically significant(P > 0.05).Conclusion:The treatment of Dubberley-B distal humeral coronal fractures is safe and effective through either the extensile lateral approach or the posterior triceps-sparing approach(Triceps approach),but the extensile lateral approach provides adequate exposure of the distal humeral articular surface and strong fixation with microplates,in addition,It is better in the management of combined injuries such as radial head fractures,LUCL injuries and avulsion fractures of the lateral humeral epicondyle and achieves better functional outcomes of the elbow with less operative time. |
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