title: Paratricipital-triceps splitting "two-window" approach for distal humerus fractures.
abstract: Commonly, distal transcondylar and intra-articular distal humerus fractures are treated through a transolecranon approach. Other options for exposure, open reduction, and internal fixation exist to prevent the reported complications of olecranon osteotomy. The technique of triceps sparing access, as it has been reported before by others, allow adequate exposure in most of distal humerus fractures except for multifragmentary, mainly intra-articular types. We demonstrate the technique of the "two-window" approach, which combines a paratricipital posteromedial access with splitting the triceps lateral to the triceps tendon. Through a posteromedial incision, all surfaces of the distal humerus were accessed without muscle detachment from the olecranon. This approach does not compromise the ligamentous joint stability. In addition, the stabilizing effect of the anconeus muscle is not impaired because continuity with the lateral portion of the triceps is preserved, and denervation is avoided. It is extensile and provides adequate exposure of articular fracture comminution with the added advantage of the intact olecranon as a template for reduction. However, because the triceps is still in continuity it permits conversion to a transolecranon approach as necessary. The two-window approach is our preferred approach for all distal humerus fractures inclusively C3 fractures according to the ASIF/AO classification, except for complex volar shear fractures.
authors.affiliation: Clinic for Hand Surgery Bad Neustadt, Bad Neustadt an der Saale, Federal Republic of Germany. muehldorfer3@gmx.de
authors.forename: Marion
authors.initials: M
authors.lastname: Mühldorfer-Fodor
authors.forename: Halil
authors.initials: H
authors.lastname: Bekler
authors.forename: Valerie M
authors.initials: VM
authors.lastname: Wolfe
authors.forename: Jason
authors.initials: J
authors.lastname: McKean
authors.forename: Melvin Paul
authors.initials: MP
authors.lastname: Rosenwasser
mesh_terms: D017885:Collateral Ligaments / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000379:methods; D018460:Fractures, Comminuted / Q000601:surgery; D018737:Hand Strength; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery*; D017060:Patient Satisfaction; D011183:Postoperative Complications