title: The triceps reflecting approach (Bryan-Morrey) for distal humerus fracture osteosynthesis.
abstract: BACKGROUND
  "Chevron"-Olecranon osteotomies are commonly used for the approach to intraarticular distal humerus fractures but are often associated with procedure related complications. We studied the triceps reflecting approach (TRA) with preservation of the extensor apparatus as a safe alternative giving a sufficient exposure to the elbow joint and helping to achieve anatomical fracture reduction with the intact olecranon as a template.
  
  
  METHODS
  We performed a retrospective review at two trauma centres and identified 31 skeletally mature distal humerus fractures treated with a TRA. 24 of the patients returned to follow-up including history recording, physical examination with functional analysis of the operated vs the normal site with the DASH and Mayo scores, measurement of range of motion, isometric elbow strength measurement and radiographic documentation.
  
  
  RESULTS
  Mean duration of FU was 51 months (24 months-12 years) in 24 patients, 13 female, 11 male with an average age of 57.7 years (range 17-89). AO Classification showed five A2, one B2, two C1, 9 C2 and 7 C3 fractures. Radiologic control showed adequate reduction, distal humeral alignment and fracture healing in all patients. The strength analysis of flexion and extension revealed no statistically relevant loss of strength at last FU. Range of motion was excellent.
  
  
  CONCLUSIONS
  The TRA is a valuable option for ORIF in distal intraarticular humerus fractures. It preserves the normal joint anatomy of the olecranon and avoids the potential complications associated with olecranon osteotomy. The clinical outcome parameters of our series revealed excellent maintenance of strength compared to the contralateral side.
authors.affiliation: Department of Traumatology, University Hospital Basel, Spitalstrasse 21, CH-3041 Basel, Switzerland. lukas.iselin@usb.ch.
authors.forename: Lukas Daniel
authors.initials: LD
authors.lastname: Iselin
authors.forename: Tobias
authors.initials: T
authors.lastname: Mett
authors.forename: Reto
authors.initials: R
authors.lastname: Babst
authors.forename: Marcel
authors.initials: M
authors.lastname: Jakob
authors.forename: Daniel
authors.initials: D
authors.lastname: Rikli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004551:Elbow Joint / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D006810:Humeral Fractures / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000502:physiology; D011859:Radiography; D012189:Retrospective Studies; D055815:Young Adult